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Public Document No. 84 

m\t Gfommamnealtl) nf WasaacljuBetta 



ANNUAL REPORT 



OF 



THE TRUSTEES 



OF THE 



>>;^^ ^, Boston State Hospital - 



FOR THE 



YEAK ENDING NOVEMBER 30, 1926 



Thk Eighty-sixth Annual Eepoet of the Hospital 
Founded in 1839 by the City of Boston 




I'l BLICATION OF THIS DOCUMENT APPBOVED UV THE COMMISSION ON FlNAXCE AND ADMINISTRATION 
500. 4-'27 Order 8787. 



OCCUPATIONAL PRINTING PLANT 
DEPARTMENT OF MENTAL DISEASES 
GARONSR STATE COLONY 
PRINTERS 



BOSTON STATE HOSPITAL. 



BOARD OF TRUSTEES 

Henry Lefavour, Chairman, Boston. 

Mrs. Katherine G. Devine. Secretary, Milton. ij.. 

William F. Whittemore, Boston. 

Charles B. Frothingham, M.D., Lynn. 

Mrs. Edna W. Dreyfus, Brookline. 

David M. Watchmaker, Boston. 

J. Waldo Pond, Boston. 

CONSULTING PHYSICIANS 

John L. Ames, M.D., Intsrnist. 
William E. Preble, M.D., Internist. 
Albert Evans, M.D., Internist. 
Fred B. Lund, M.D., Surgeon. 
Irving J. Walker, M.D., Si.rgeon. 
Llewellyn H. Rockwell., M.D., Surgeon. 
Malcolm H. Storer, MD., Gynecologist. 
Charles J. White, M.D., Dermatologist. 
Ralph W. Hatch, M.D., Ophthalmologist. 

Edwin A. Meserve, M.D., Laryngologist, Rhinologist, and Otologist. 
Grace E. Rochford, M.D., Gynecologist, 

OFFICERS OF THE HOSPITAL 

•James V. May, M.D., Superintendent. 
E. C. Noble, M.D., Assistant Superintendent. 
Mary E. Gill Noble, Senior Assistant Physician. 
Edmund M. Pease, M.D., Senior Assistant Physician. 
Geneva Tryon, M.D., Senior Assistant Physician. 

, Senior Assistant Physician. 

Herbert E. Herrin, M.D., Senior Assistant Physician. 
Roy D. Halloran, M.D., Senior Assistant Physician. 
George G. Kelly, M.D., Assistant Physician. 
Alexander Marcotte, M.D., Assistant Physician. 
Janice Rafuse, M.D., Assistant Physician. 
Ilse Lauber, M.D., Assistant Physician. 

Alberta S. B. Guibopd, M.D , Assistant Physician {School Clinic). 

. Pa^kulogist. 

Martin P. Rose, D.D.S., Dentist. 
Arthur E. Gilman, Steward. 
Adeline J. Leary, Treasurer. 

TRUSTEES' REPORT 

To His Excellency the Governor and the Honorable Council: 

The trustees of the Boston State Hospital have the honor to submit herewith 
their eighteenth annual report. The trustees have held their usual monthy 
meetings, at each of which the superintendent has submitted a detailed account of 
the operations of the hospital and of the financial status, with such recommendations 
as seemed appropriate. Under the present law and practice but little is left to the 
discretion of the trustees. They have, however, kept a careful oversight of the 
affairs of the institution and believe that it is being administered as satisfactorily 
as possible under the existing conditions. 



> 157 

J'.D. 84 ^^4^ 3 

Persons Under the Care of the Trustees 
At the beginning of the year there were 2,112 patients in the hospital, 9 in private 
care, and 259 on visit or escape, a total of 2,380 persons. At the close of the year 
the total I amber was 2,362, of whom 2,126 were in the hospital, 9 were in private 
care, and 227 on visit or escape. 

Cost of Maintenance 
The amount estimated a year ago as needed for the maintenance of the hospital 
was $931,417.17; the amount allowed by the General Court was $780,235.00, 
the reductions being largely in the allowances for personal service, food, and 
repairs and renewals. To this should be added $11,562.56 brought over from the 
previous year. Notwithstanding the many vacancies that were left unfilled, the 
tru':tees were obliged to ask the Department for $4,000 as an additional allowance 
for personal services out of the fund appropriated for such deficiencies. The 
effective care of the patients, of course, suffers to the extent that the full quota 
of physicians and attendants is not maintained. The price of food were for- 
tunately less than those estimated, and many needed repairs were postponed, so 
that the hospital has been able otherwise to keep within the appropriation. 

Estimates for Maintenance 
The following are the estimates for the amount needed for maintenance for the 
coming year based on the established salary scales and the established per capita 
allowances, the number of patients being taken as 2,200: 

Personal services 

Religious instruction 

Travel and transportation 

Food 

Clothing and materials 

Heat, light and power 

Medical and general care 

Furnishings and supplies 

Farm 

Garage, stable and grounds 

Repairs ordinary 

Repairs and renewals 



New Construction and Improvements 
No appropriation for new construction was made by the General Court in 1926, 
but out of a special appropriation for fire protection, made in 1925, $18,000.00 was 
allocated to this hospital and a part of this has been expended. The following is 
a list of the additions and improvements needed at this hospital which were recom- 
mended by the trustees: 

1. Administration building and staff quarters $180,000.00 

2. Extension to sewer, water and steam lines 13,000.00 

3. Purchase of additional land 50,000.00 

4. Addition to garage 4,200.00 

5. Cottage for farm employees 30,000.00 

6. Concrete platform for coal storage 6,000.00 

7. Reception building 350,000.00 

8. Building for male employees, West group 165,000 . 00 

9. Removal and remodelling administration 

building. East Group 30,000.00 

10. New greenhouse 2,500.00 



$417,902 


.70 


2,080 


.00 


7,181 


.10 


232,069 


.95 


35,521 


.50 


79,198 


.10 


31,791, 


.81 


45,094: 


.31 


7,112. 


55 


7,336. 


56 


20,000. 


00 


18,842. 


00 


$904,130.58 



4 P.D. 84 

11. PaintShop 5,500.00 

12. New watch clock system, West Group 4,000 . 00 

13. Building for tuberculous patients 40,000.00 

14. Laboratory building 25,000.00 

15. Assembly building 175,000.00 

16. Industrial building 100,000.00 



Total $1,180,200.00 



Most of the foregoing items have been repeatedly requested, and until they are 
realized, the hospital plant cannot be regarded as complete. One difficulty in 
securing competent medical officers is the lack of suitable quarters, and until these 
are provided the hospital cannot compete with institutions elsewhere, especially 
outside of the state where the conditions are more attractive. Only two of these 
items furnish additional accommodations for patients, but these are urgently 
needed. The hospital has been housing between 2100 and 2200 patients, while a 
measure of its standard capacity shows room for only 1,788. The sleeping space 
is not far below the standard, but it has been secured at the expense of the necessary 
day space. Provision for a reception building and a building for tuberculosis patients 
would greatly diminish this congestion, as well as furnish facilities for a much-needed 
classification. 

HENRY LEFAVOUR EDNA W. DREYFUS 

KATHERINE G. DEVINE DAVID M. WATCHMAKER 

WILLIAM F. WHITTEMORE J. WALDO POND 

CHARLES B. FROTHINGHAM 
November 30, 1926. Trustees. 

SUPERINTENDENTS REPORT 

To the Board of Trustees of the Boston State Hospital: 

The following is a report of the activities of the hospital for the statistical 
year ending September 30, 1926, and the fiscal year ending November 30, 1926. 
Founded by the City of Boston in 1839, this marks the completion of the eighty- 
seventh year of the institution as a hospital for mental diseases, and the eighteenth 
year of its history as a State hospital. 

Movement of Population 

The census of the hospital on September 30, 1925, was as follows: in the vv^ards, 
men, 912, women, 1,255, total, 2,167; at home on visit, men, 96, women, 177, 
total, 273; boarding out, men, none, women, 10; and out on escape, men, 13, 
women, 1, total, 14; making a total of 2,464, 1,021 men and 1,443 wom.en, in the 
custody of the hospital. 

Tw^o hundred and seventy-five men and 355 women, a total of 630, were received 
during the year. This included the following: first admissions as insane,* men, 
171, women, 225, total, 396; readmissions as insane,! men, 30, women, 40, total, 
70; first admissions, temporary care, men, 28, women, 36, total, 64; readmissions, 
temporary care, men, 28, women, 28, total, 56; and transferred from other institu- 
tions, men, 18, women, 26, total, 44. Three hundred and thirty-nine cases, in- 
cluding 137 men and 202 women, were discharged during the year. Six men and 
58 women, a total of 64, were transferred to other institutions. One hundred and 
forty-seven men and 179 women, a total of 326, died during the year. 

*Including 1 man and 2 women committed from temporary care of the preceding 
year. 

jlncluding 2 women committed from temporary care of the preceding year. 



P.D. 84 5 

The census on September 30, 1926, was as follows: in the wards, men 898, 
women, 1,244, total, 2,122; at home on visit, men, 105, women, 121, total, 226; 
boarding out, men, none, women, 7; and out on escape, men, 2, women, 3, total 5; 
making a total of 2,360, 1,005 men and 1,355 women, in the custody of the hospital. 

The total number of cases treated during the year was 3,089, 1,295 men and 1,794 
women. 

The average daily number of patients for the statistical year was: men, 1,011.08, 
women, 1,370.33, total 2,381.41. The average daily number in the wards was: 
men, 907.67, women, 1,216.85, total, 2,124.52; or 89.21 per cent of the whole 
number. The average daily number at home on visit was: men, 97.11, women, 
142.87, total, 239.98, or 10.08 per cent. The average daily number boarding out 
was: men, none, women, 8.26, or .35 per cent. The average daily number out on 
escape was, men, 6.30, women, 2.35, total, 8.65, or .36 per cent. The average daily 
number of committed cases was: men, 902.84, women, 1,211.21, total 2,114.05, or 
99.51 per cent of the number in the wards. There were no voluntary cases during 
the year. The average daily number of emergency cases was: men, .025, women, 
.033, total, .058, or .0027 per cent. The average daily number of temporary care 
cases was: men, 4.83, women, 5.64, total, 10.47, or .49 per cent. The average daily 
number of cases under complaint or indictment was: men, 7.3, women, 2.02, total, 
9.32, or .44 per cent. The average daily number of epileptics was: men, 10.66, 
women, 10.37, total, 21.03, or .99 per cent. The private cases are included with the 
reimbursing cases. The average daily number of reimbursing cases was: men, 
71.03, women, 170.13, total, 241.16, or 11.35 percent. The average daily 
number of cases supported by the state was: men, 836.64, women, 1,046.72, 
total, 1,883.36, or 88.65 per cent. There was a daily average of 47 ex- ser- 
vice men. 

The recovery rate, based on the number of first admissions, was 14.56 per cent; 
based on the total number cared for during the year, 2.17 per cent; based on the 
average daily number in the wards, 3.15 per cent; and based on the total admissions 
for the year, 10.64 per cent. 

The death rate, based on the total number cared for during the year, was 10.54 
per cent; and based on the average daily number in the wards, 15.35 per cent. 
The death rate of the hospital is unusually large when compared with that of 
other institutions of a similar character, as about thirty-five per cent of the popu- 
lation is of the infirmary type, and nearly ten per cent represents actual bed cases. 
This is due to the fact that the acutely ill, the senile and the infirm cases from the 
city cannot be readily transported to distant institutions, and are therefore com- 
mitted to the Boston State Hospital. It is obvious that for the same reason too 
much significance should not be attached to the recovery rate. 

Of the first admissions as insane, 203, or 51.26 per cent, were foreign born, and 
336, or 84.84 per cent, were of foreign parentage on one or both sides. Sixty-eight, 
or 17.17 per cent, were aliens. Citizenship was unascertained in 52, or 13.13 per 
cent. Of 2,533 consecutive first admissions as insane, for the six-year period 
beginning October 1, 1920, 1,269, or 50.10 per cent, were foreign born; 2,050, or 
80.93 per cent, were of foreign parentage on one or both sides, 482, or 19.03 per 
cent, were aliens, and citizenship was unascertained in 314, or 12.39 per cent. 

The average age on admission was 52.7; 161, or 40.66 per cent, were sixty years 
of age or over, and 81, or 20.45 per cent, were seventy years of age or over. For 
the six-year period beginning October 1, 1920, the average age on admission was 
50.99, 925, or 36.52 per cent, were sixty years of age or over; and 489, or 19.3 
per cent, were seventy years of age or over. 

The first admissions for the year, classified according to legal status, were as 
follows: 

Males Females Total 

Committed cases (section 51, chapter 123, General Laws) 116 147 263 

Voluntary admissions (sections 86. chapter 123, General Laws) 



6 P.D. 84 

Emergency commitments (sections 78, chapter 123, General 

Laws) 15 6 

Pending examination and hearing (section 55, chapter 123, 

General Laws) 

Temporary care cases (section 79, chapter 123, General Laws).. 40 59 104 

Observation cases (section 77, chapter 123, General Laws) 9 14 23 



Total 171 225 396 



The distribution of first admissions for the year, classified according to legal 
status, as shown by the above table, is therefore as follows: committed cases 
(section 51, chapter 123, General Laws), 66.41 per cent; emergency cases (section 
78, chapter 123, General Laws), 1.52 per cent; temporary care cases (section 79, 
chapter 123, General Laws), 26.26 per cent; and observation cases (section 77, 
chapter 123, General Laws), 5.81 per cent. For the six years beginning October 
1, 1920, the distribution of first admissions, classified according to legal status, 
was as follows: committed cases (section 51, chapter 123, General Laws), 1,919, 
or 76.94 per cent; emergency cases (section 78, chapter 123, General Laws), 42, 
or 1.66 per cent; temporary care cases (section 79, chapter 123, General Laws , 
400, or 15.79 per cent; observation cases (section 77, chapter 123, General Laws , 
118, or 4.66 per cent; and cases held under complaint or indictment (section 100, 
chapter 123, General Laws), 19, or .75 per cent. During the above period there 
v/as only one case pending examination and hearing (section 55, chapter 123, 
General Laws), and one Boston Police case (chapter 307, Acts of 1910). No 
voluntary cases (section 86, chapter 123, General Laws) have been received since 
1921, during which year there were three. 

The first admissions for the year included 263 committed cases. Of these, 5, 
or 1.9 per cent, were discharged; 2, or .76 per cent, were transferred to other in- 
stitutions for mental diseases; 58, or 22.05 per cent, died; and 198, or 75.29 per 
cent, remained at the end of the statistical year. 

Of the first admissions for the year, six were emergency cases, all of which were 
committed within a few days after admission. 

One hundred and four of the first admissions during the year were temporary 
care cases. Of these, 92, or 88.46 per cent, were committed; 1, or .96 per cent, 
changed to emergency status (section 78, chapter 123, General Laws); and 11, or 
10.58 per cent, to observation status (section 77, chapter 123, General Laws). 

The first admissions for the year also included 23 cases admitted for observation 
under the provisions of section 77, chapter 123, General Laws, all of which were 
subsequently committed. 

Of the 396 first admissions for the year, the cause was unascertained or no cause 
given in 100 cases, or 25.25 per cent. In the 296 cases where a definite cause was 
assigned, the etiological factors reported may be classified as follows: senility, 40, 
or 13.51 per cent; arteriosclerosis, 110, or 37.16 per cent; syphilis, 37 or 12.5 per 
cent; alcoholism, 36, or 12.16 per cent; involutional changes, 20, or 6.76 per cent; 
and traumatism, 2, or .67 per cent. There was a family history of mental diseases 
in 39, or 9.85 per cent, mental defects in 7, or 1.76 per cent, and nervous diseases 
in 13, or 3.28 per cent, of the first admissions. Of the 2,533 first admissions to the 
hospital since October 1, 1920, the cause was unascertained or no cause given in 
813 cases, or 32.10 per cent. In the 1,720 cases where a definite cause loas assigned, 
the etiological factors are classified as follows: senility, 322, or 18.72 per cent; 
arteriosclerosis, 368, or 21.39 per cent; syphilis, 258, or 15.00 per cent; alcoholsm, 
241, or 14.01 per cent; involutional changes, 105, or 6.10 per cent; and traumatism, 
34, or 1.97 per cent. There was a family history of mental diseases in 401, 
or 15.83 per cent, mental defects in 48, or 1.90 per cent, and nervous diseases in 
116, or 4.58 per cent, of the first admissions. 

The forms of mental disease shown by the first admissions for the year, briefly 



P.D. 48 7 

summarized, were as follows: senile psychoses, 39, or 9.85 per cent; psychoses with 
cerebral arteriosclerosis, 108, or 27.27 per cent; general paralysis, 33, or 8.33 per 
cent; psychoses with other brain or nervous diseases, 10, or 2.77 per cent; alcoholic 
psychoses, 28, or 7.07 per cent; psychoses with other somatic diseases, 15, or 4.16 
per cent; manic-depressive psychoses, 55, or 14.00 per cent; involution melancholia, 
8, or 2.02 per cent; dementia praecox, 28, or 7.07 per cent; paranoia or paranoid 
conditions, 23, or 5.81 per cent; psychoses with mental deficiency, 10, or 2.77 per 
cent; undiagnosed psychoses, 27, or 6.82 per cent; and all other psychoses one 
per cent or less. Four, or 1.01 per cent, were without psychosis. The psychoses 
of all first admissions are shown in Table No. 6, on page 33. The forms of mental 
disease shown by the 2,533 first admissions since October 1, 1920, are summarized 
as follows: senile psychoses, 375, or 14.80 per cent; psychoses with cerebral arterio- 
sclerosis, 486, or 19.18 per cent; general paralysis, 239, or 9.44 per cent; psychoses 
with other brain or nervous disease, 47, or 1.86 per cent; alcoholic psychose,s 191, 
or 7.54 per cent; psychoses with other somatic diseases, 73, or 2.88 per cent; 
manic-depressive psychoses, 316, or 12.50 per cent; involution melancholia, 59, or 
2.33 per cent; dementia praecox, 345, or 13.62 per cent; paranoia or paranoid 
conditions, 133, or 5.25 per cent; psychoses with mental deficiency, 66, or 2.55 per 
cent; undiagnosed psychoses, 77, or 3.01 per cent; and all other psychoses one per 
cent or less. Twenty-two, or .86 per cent, were without psychosis. Attention 
should be called here again to the fact that the psychoses represented by our first 
admissions are not consistent with the admission rate shown by other hospitals. 
This is due to the fact that the acutely ill, the senile and infirm case from the 
City of Boston cannot be removed to distant institutions and for that reason are 
brought here. It does not, of course, mean that the admission rates for manic- 
depressive insanity and for dementia praecox are lower in Boston. As a matter 
of fact, if the senile and arteriosclerotic cases are disregarded, it will be readily 
apparent that this is not the case. 

The forms of mental disease shown by the readmissions for the year, briefly 
summarized, were as follows: senile psychoses, 2, or 2.86 per cent; psychoses with 
cerebral arteriosclerosis, 7, or 10 per cent; alcoholic psychoses, 8, or 11.41 per cent; 
manic-depressive psychoses, 23, or 32.86 per cent; dementia praecox, 17, or 24.29 
per cent; paranoia or paranoid conditions, 3, or 4.29 per cent; psychoneuroses and 
neuroses, 1, or 1.43 per cent; psychoses with psychopathic personality, 1, or 1.43 
per cent; psychoses with mental deficiency, 7, or 10 per cent and without psychosis, 
1, or 1.43 per cent. 

Of these readmissions, 34, or 48.57 per cent, were committed under the provisions 
of section 51, chapter 123, General Laws; 27, or 38.57 percent, were temporary 
care cases (section 79, chapter 123, General Laws); 8, or 11.43 per cent, were 
observation cases (section 77, chapter 123, General Laws); and 1, or 1.43 per cent, 
an emergency case (section 78, chapter 123, General Laws). No voluntary cases 
(section 86, chapter 123, General Laws) and no cases held under complaint or 
indictment (section 100, chapter 123, General Laws) or pending examination and 
hearing (section 55, chapter 123, General Laws) were included in the readmissions 
for the year. 

The following tables show the psychoses of all first admissions for the six-year 
period beginning October 1, 1920, according to legal status: 



8 P.D. 84 

Psychoses of Committed Cases (Sedion 51, Chapter 123, General Laws) 



M. 


F. 


T. 


Percent- 
age OF 
Total 


11 





11 


.56 


79 


188 


267 


13.70 


164 


160 


324 


16.62 


163 


44 


207 


10.62 


5 


5 


10 


.51 


1 





1 


.05 





5 


5 


.26 


20 


13 


33 


1.69 


104 


41 


145 


7.44 


1 


5 


6 


.30 





2 


2 


.10 


17 


31 


48 


2.46 


84 


176 


260 


13.34 


22 


28 


50 


2.60 


160 


143 


303 


15.55 


19 


93 


112 


5.75 


10 


o 
£t 




<;i 

. Dl 


4 


6 


10 


.51 


4 


9 


13 


.66 


22 


30 


52 


2.67 


26 


33 


59 


3.03 


9 


10 


19 


.97 


925 


1024 


1949 


100.00 



Traumatic psychoses 

Senile psychoses 

Psychoses with cerebral arteriosclerosis. 

General paralysis 

Psychoses with cerebral syphilis 

Psychosis with Huntington's chorea. . . . 

Psychoses with brain tumor 

Psychoses with other brain or nervous 

Alcoholic psychoses • • • 

Psychoses due to drugs or other exogenous toxins . 

Psychoses with pellagra 

Psychoses with other somatic diseases 

Manic-depressive psychoses 

Involution melancholia 

Dementia praecox 

Paranoia or paranoid conditions 

Epileptic psychoses 

Psychoneuroses and neuroses 

Psychoses with psychopathic personality 

Psychoses with mental deficiency 

Undiagnosed psychoses 

Without psychosis 



Total 925 



Psychoses of Emergency Commitments (Sections 78, Chapter 123, General Laws) 



Traumatic psychosis 

Senile psychoses 

Psychoses with cerebral arteriosclerosis 

General paralysis 

Psychosis with other brain or nervous 

Alcoholic psychoses 

Psychosis with other somatic disease . 

Manicndepressive psychoses . 

Involution melancholia 

Dementia praecox 

Paranoia or paranoid conditions 

Undiagnosed psychoses 

Without psychosis 

Total 



M. 



17 



F. 



25 



T. 



42 



Percent- 
age OF 
Total 



2.38 
14.29 
16.67 
4.77 
2.38 
7.14 
2.38 
11.90 
7.14 
11.90 
11.90 
4.77 
2.38 



100.00 



Psychoses of Temporary Care Cases (Section 79, Chapter 123, General Laws). 



Traumatic psychoses 

Senile psychoses 

Psychoses with cerebral arteriosclerosis 

General paralysis 

Psychoses with cerebral syphilis 

Psychosis with brain tumor 

Psychoses with other brain or nervous diseases . . . 

Alcoholic psychoses 

Psychosis due to drugs or other exogenous toxins . 

Psychoses with other somatic diseases 

Manic-depressive psychoses , 

Involution melancholia 

Dementia praecox 

Paranoia or paranoid conditions 

Epileptic psychoses 

Psychoneuroses and neuroses 

Psychoses with psychopathic personality 

Psychoses with mental deficiency 

Undiagnosed psychoses 

Without psychosis 



Total 181 



M. 



F. 



219 



T. 



2 
92 
141 
19 
2 
1 
9 
18 
1 
24 
34 
5 
17 
10 
2 
3 
2 
5 
12 
1 



400 



Percent- 
age OF 
TOTAL 



.50 
23.00 
35.25 
4.75 
.50 
.25 
2.25 
4.50 
.25 
6.00 
8.50 
1.25 
4.25 
2.50 
.50 
.75 
.50 
1.25 
3.00 
.25 



100.00 



P.D. 84 9 



Psychoses of Observation Cases (Section 77, Chapter 123, General Laws). 





M.. 


F. 


T. 


Percent- 
age OF 
Total 




1 





1 


.84 




3 


4 


7 


5 . 93 




9 


5 


14 


11 .86 




9 


1 


10 


8 .48 




1 


1 


2 


1 .70 







1 


1 


.84 




3 


1 


4 


3 .40 




15 


2 


17 


14.40 




6 


10 


16 


13 . 56 




n 
K) 


1 


1 


. 84 




rj 
I 


Q 
O 


10 






1 
i. 


O 


D 




Psychoneuroses and neuroses 


4 


2 


6 


5.09 




4 


2 


6 


5.09 




5 


4 


9 


7.63 







2 


2 


1.70 







1 


1 


.84 


Total 


68 


50 


118 


100.00 



The psychoses represented by the three Voluntary cases (Section 86, Chapter 
123, General Laws) were as follows: 1 each, senile psychosis, general paralysis, 
and dementia praecox. The psychosis of the one case Pending Examination and 
Hearing (Section 55, Chapter 123, General Laws) was senile psychosis. The 
psychosis of the one Boston Police Case (Chapter 307, Acts of 1910) was dementia 
praecox. 

Two hundred and sixteen temporary care cases (section 79, chapter 123, General 
Laws) were admitted during the year ending September 30, 1926. Of these, 118, 
or 54.63 per cent, were committed under the provisions of section 51, chapter 123, 
General Laws; 34, or 15.74 per cent, changed to observation status; none to volun- 
tary; 2, or .93 per cent, to emergency status; 55, or 25.46 per cent, were discharged; 
6, or 2.78 per cent, died; and 1, or .46 per cent, remained at the end of the statistical 
year. Of the 55 discharged, 3, or 5.45 per cent, were discharged as recovered; 10, 
or 18.18 per cent, as improved; 32, or 58.19 per cent, as unimproved; and 10, or 
18.18 per cent, as without psychosis. 

Ten emergency cases (section 78, chapter 123, General Laws), including two cases 
from section 79, were admitted during the year. Eight of these were committed 
in accordance with section 51, chapter 123, General Laws; two were discharged 
(one as improved and one as unimproved,) and none remained in the hospital at 
the end of the statistical year. 

Ninety-one observation cases (section 77, chapter 123, General Laws), including 
34 cases from section 79, were admitted during the year. Of these, 42, or 46.16 
per cent, were subsequently committed under the provisions of section 51, chapter 
123, General Laws; 39, or 42.86 per cent, discharged; 5, or 5.49 per cent, died; 
none were transferred; and 5, or 5.49 per cent remained at the end of the statistical 
year. Of the 39 discharges, 6, or 15.38 per cent, were discharged as recovered; 7, 
or 17.95 per cent, as improved; 1, or 2.57 per cent, as unimproved; and 25, or 64.10 
per cent, as without psychosis. 

Six cases held under complaint or indictment (section 100, chapter 123, General 
Laws) were admitted during the year. Of these, four were discharged and returned 
to Court (two as recovered and two as without psychosis), and two remained in 
the hospital at the end of the statistical year. 

No voluntary cases (section 86, chapter 123, General Laws) and no cases pending 
examination and hearing (section 55, chapter 123, General Laws) were admitted 
during the year. 



10 P.O. 84 

The following table shows the psychoses of all cases admitted as temporary care, 
all forms, and subsequently committed under the provisions of section 51, chapter 
123, General Laws, for the six-year period beginning October 1, 1920. 



Traumatic psychoses 

Senile psychoses 

Psychoses with cerebral arteriosclerosis 

General paralysis 

Psychoses with cerebral syphilis 

Psychoses with Huntington's chorea 

Psvchosis with brain tumor 

Psychoses with other brain or nervous diseases. . . . 

Alcoholic psychoses 

Psychoses due to drugs and other exogenous toxins 

Psychoses with pellagra 

Psychoses with other somatic diseases 

Manic-depressive psychoses 

Involution melancholia 

Dementia praecox 

Paranoia or paranoid conditions 

Epileptic psychoses 

Psychoneuroses and neuroses 

Psychoses with psychopathic personality 

Psychoses with mental deficiency 

Undiagnosed psychoses 

Without psychosis 

Total 



M. 



334 



The psychoses represented by the cases discharged from the hospital during 
the year were as follows: traumatic psychoses, 3 or 1.29 per cent; senile psychoses, 
13, or 5.58 per cent; psychoses with cerebral arteriosclerosis, 12, or 5.15. per cent; 
general paralysis, 8, or 3.43 per cent; psychoses with cerebral syphilis, 2, or .85 per 
cent; psychoses with other brain or nervous diseases, 2, or .85 per cent; alcoholic 
psychoses, 20, or 8.58 per cent; psychoses with other somatic diseases, 2, or .85 
per cent; manic-depressive psychoses, 79, or 33.95 per cent; involution melancholia, 
6, or 2.57 per cent; dementia praecox, 38, or 16.31 per cent; paranoia or paranoid 
conditions, 12, or 5.15 per cent; epileptic psychosis, 1, or .43 per cent; psycho- 
neuroses and neuroses, 4, or 1.71 per cent; psychoses with psychopathic personality 
4, or 1.71 per cent; psychoses with mental deficiency, 17, or 7.30 per cent; undiag- 
nosed psychoses, 3, or 1.29 per cent; and without psychosis, 7, or 3.00 per cent. 

The total number of cases discharged during the year was 233. Of this number 
54, or 23.18 per cent, were discharged as recovered; 132, or 56.66 per cent, as 
improved; 40, or 17.16 per cent, as unimproved; and 7, or 3.00 per cent, without 
psychosis. Of the 54 recovered cases, 6, or 11.11 per cent, were cases of alcoholic 
psychosis; 38, or 70.38 per cent, manic-depressive psychosis; 5, or 9.26 per cent, 
psychosis with mental deficiency; and 1, or 1.85 per cent, of each of the following: 
psychosis with cerebral arteriosclerosis, psychosis with other somatic disease, 
involution melancholia, paranoia or paranoid conditions, psychosis with psycho- 
pathic personality. Of the 132 cases discharged as improved, 2, or 1.52 per cent, 
were cases of traumatic psychosis; 5, or 3.79 per cent, senile psychosis; 3, or 2.27 
per cent, psychosis with cerebral arteriosclerosis; 7, or 5.30 per cent, general 
paralysis; 2, or 1.52 per cent, psychosis with cerebral syphilis; 2, or 1.52 per cent, 
psychosis with other brain or nervous diseases; 12, or 9.08 per cent, alcoholic 
psychosis; 1, or .76 per cent, psychosis with other somatic diseases; 35, or 26.52 
per cent, manic-depressive psychosis; 3, or 2.27 per cent, involution melancholia; 
32, or 24.24 per cent, dementia praecox; 6, or 4.55 per cent, paranoia or paranoid 
conditions; 1, or .76 per cent, epileptic psychosis; 4, or 3.03 per cent, psycho- 
neuroses and neuroses; 3, or 2.27 per cent, psychosis with psychopathic personality; 
11, or 8.33 per cent, psychosis with mental deficiency; and 3, or 2.27 per cent, 
undiagnosed psychosis. Of the 40 cases discharged as unimproved, 1, or 2.5 per 
cent, was a case of traumatic psychosis; 8, or 20 per cent, were cases of senile 



P.D. 84 11 

psychosis; 8 or 20 per cent, psychosis with cerebral arteriosclerosis; 1, or 2.5 per 
cent, general paralysis; 2, or 5 per cent, alcoholic psychosis; 6, or 15 per cent, 
manic-depressive psychosis; 2, or 5 per cent, involution melancholia; 6, or 15 per 
cent, dementia praecox; 5, or 12.5 per cent, paranoia or paranoid conditions; and 
1, or 2.5 per cent, psychosis with mental deficiency. 

A study of the entire hospital residence (including other institutions for mental 
diseases) of the cases discharged during the statistical year is of considerable 
interest. Seventeen, or 7.3 per cent, were discharged after a residence of less than 
one month; 81, or 34.76 per cent, after a residence of from one to six months; 
49, or 21.03 per cent, from six months to one year; 31, or 13.31 per cent, from one 
to two years; 17, or 7.3 per cent, from two to three year; 11, or 4.72 per cent, three 
to four years; 5, or 2.14 per cent, four to five years; 17, or 7.3 per cent, five to ten 
years; and 5, or 2.14 per cent, ten years and over. The average duration of hospital 
residence was one year, eight months, and nineteen days. 

Of the 313 deaths occurring during the year, 213, or 68.05 per cent, represented 
cases dying at the age of sixty or over. In 120 cases, or 38.34 per cent, death 
occurred at the age of seventy or over. Of the 1,581 deaths occurring at the 
hospital during the six-year period beginning October 1, 1920, 904, or 57.18 per 
cent, were cases dying at the age of sixty or over; and in 540 cases, or 34.16 per 
cent, death occurred at the age of seventy or over. 

The principal causes of death during the year were as follows: bronchopneumonia^ 
99, or 31.63 per cent; arteriosclerosis, 34, or 10.86 per cent; tuberculosis of the 
lungs, 22, or 7.03 per cent; endocarditis and myocarditis, 88, or 28.11 per cent; 
general paralysis of the insane, 15, or 4.79 per cent; diarrhea and enteritis, 9, or 
2.87 per cent; lobar pneumonia, 14, or 4.47 per cent; cerebral hemorrhage, 9, or 
2.87 per cent; and cancer, 8, or 2.56 per cent. 

The psychoses represented by deaths occurring in the hospital during the year 
were as follows: senile psychoses, 66, or 21.09 per cent; psychoses with cerebral 
arteriosclerosis, 107, or 34.19 per cent; general paralysis, 38, or 12.14 per cent; 
psychoses with cerebral syphilis, 5, or 1.60 per cent; psychoses with Huntington's 
chorea, 2, or .64 per cent; psychoses with other brain or nervous diseases, 6, or 1.91 
per cent; alcoholic psychoses, 10, or 3.20 per cent; psychoses with other somatic 
diseases, 11, or 3.52 per cent; manic-depressive psychoses, 9, or 2.88 per cent; 
involution melancholia, 8, or 2.55 per cent; dementia praecox, 34, or 10.86 per cent; 
paranoia or paranoid conditions, 8, or 2.55 per cent; psychoses with mental de- 
ficiency, 4, or 1.27 per cent; and each of the following, 1, or .32 per cent: traumatic 
psychosis, psychosis with brain tumor, epileptic psychosis, psychoneurosis and 
neurosis, and undiagnosed psychosis. Of the 66 cases of senile psychosis dying in 
the hospital during the year, 27, or 40.91 per cent, were due to bronchopneumonia, 
and 20, or 30.30 per cent, endocarditis and myocarditis. Of the 107 cases of 
arteriosclerotic psychosis, death was due in 31, or 28.97 per cent, to broncho- 
pneumonia, in 37, or 34:58 per cent, to endocarditis and myocarditis, and in 21, 
or 19.62 per cent, death was attributed directly to arteriosclerosis. Of the 38 cases 
of general paralysis, 18, or 47.37 per cent, were reported as dying from broncho- 
pneumonia, and in 15, or 39.47 per cent, general paralysis of the insane was given 
as the cause of death. Of the 34 cases of dementia praecox, death was due in 10, 
or 29.41 per cent, to pulmonary tuberculosis. 

Of the 313 patients dying in the hospital during the year, the total duration of 
hospital residence was as follows: one year or less, 141, or 45.05 per cent; one to 
two years, 40, or 12.78 per cent; two to three years, 32, or 10.22 per cent; three to 
four years, 10, or 3.20 per cent; four to five years, 22, or 7.03 per cent; five to six 
years, 7, or 2.23 per cent; six to seven years, 11, or 3.52 per cent, seven to eight 
years, 6, or 1.91 per cent; eight to nine years, 5, or 1.60 per cent; nine to ten years, 
10, or 3.20 per cent; ten to fifteen years, 15, or 4.79 per cent; fifteen to twenty 
years, 4, or 1.27 per cent; and over twenty years, 10, or 3.20 per cent. The psychoses 
showing the longest hospital residence were as follows: psychosis with cerebral 



12 P.D. 84 

arteriosclerosis, one over 16 years; psychosis with cerebral syphilis, one over 24 
years; alcoholic psychosis, one over 20 years; manic-depressive psychosis, one 
over 28 years; dementia praecox, two over 19 years, one each over 21, 23, 27, 30, 
and 34 years; paranoia or paranoid conditions, one over 15 years; epileptic psychosis, 
one over 40 years; and psychosis with mental deficiency, one over 21 years. The 
following shows the duration of hospital residence of all cases dying in the hospital 
during the six-year period beginning October 1, 1920; one year or less, 805, or 
50.92 per cent; one to two years, 226, or 14.29 per cent; two to three years, 141, 
or 8.92 per cent; three to four years, 73, or 4.62 per cent; four to five years, 74, 
or 4.69 per cent; five to six years, 26, or 1.64 per cent; six to seven years, 39, or 
2.47 per cent; seven to eight years, 34, or 2.15 per cent; eight to nine years, 26, or 
1.64 per cent; nine to ten years, 27, or 1.71 ..per cent; ten to fifteen years, 62, or 
3.92 per cent; fifteen to twenty years, 20, or 1.26 per cent; and over 20 years, 
26, or 1.64 per cent. In this total of 1,581 deaths, the duration of hospital residence 
was unascertained in 2, or .13 per cent. 

The following general statistical information relating to ward service should be 
of interest: 





Males 


Females 


Totals 


Percentage 


Average daily population 


907.67 


1,216.85 


2,124.52 


100.00 


In bed 


106.17 


95.15 


201.32 


9.48 




1.56 


4.75 


6.31 


29 




4.11 


15.27 


19.38 


.91 


Eating in dining rooms 


777.16 


763 . 59 


1,540.75 


72.52 


Eating on wards 


130.51 


453.26 


583.77 


27.48 


Fed by nurses 


15.59 


71.46 


87.05 


4.09 


Idle 


388.17 


660.76 


1,048.93 


49.37 


Employed 


519.50 


556.09 


1,075.59 


50.63 


Parole of grounds 


122.20 


27.60 


149.80 


7.05 


Out for exercise 


793.81 


743.86 


1,537.67 


72.38 




36.86 


115.98 


153.84 


7.24 




.62 


37.16 


37.78 


1.78 


Destructive 


4.90 


57.36 


62.26 


2.93 




73.59 


160.56 


234.15 


11.02 




21.16 


27.97 


49.13 


2.31 




342.72 


397.90 


740 . 62 


34.86 



The average daily number for the entire year is represented in each instance in 
the percentages given in the preceding table, that is: the average daily number of 
patients in bed was 201.32, or 9.48 per cent of the average daily number of patients 
in the wards of the hospital for the year, and the average daily number out for 
exercise was 1,537.67, or 72.38 per cent of the same average daily population. 
The large percentage of bed cases shown, nearly ten per cent, is explained by the 
fact that many senile and infirm cases cannot readily be removed to institutions 
outside of the metropolitan district and are of necessity received at the Boston 
State Hospital. This accounts in some measure for the large proportion of our 
patients who belong to the infirmary class, — about thirty-five per cent of the total 
number cared for. The continued shortage of trained nurses and attendants is 
partly responsible for the amount of restraint and seculsion as shown by the above 
table, although this is small. It will be observed that quite a large proportion 
of our patients goes out for exercise daily, if the percentage of infirm (including 
the bed patients) is taken into consideration. The average daily number of noisy 
patients is of considerable interest. Popular ideas regarding institutions of this 
type are not borne out by the actual number of violent patients. Eliminating 
the percentage of bed cases, the average daily number of patients employed in 
useful occupations is very gratifying. 

General Health of the Hospital 
There have been no serious epidemics in the hospital during the year, and the 
health of the patients has been good. In January there were nine cases of diarrhea 
and enteritis among the women patients in the West A and West B buildings, 



P.D. 84 13 

with four deaths, due to varying causes. We were unable to determine the origin 
of this epidemic. There were five cases of measles among the employees in the 
West Group in February, — four male attendants and a waitress in the physicians' 
dining room. All of these cases were mild and made a quick recovery. In March 
and April there were twenty-two mild cases of influenza, — one physician, two 
employees, and nineteen patients. All of these recovered. 

Various minor accidents and injuries occurred in the wards from time to time 
and were all reported in the usual manner to the Board of Trustees and the De- 
partment of Mental Diseases. There have been no suicides or homicides during 
the year. 

Six hundred and one Wassermann examinations were made for us by the State 
Department of Public Health, — 507 blood serum and 94 cerebrospinal fluid. The 
treatment of neurosyphilis has been continued by Dr. Roy D. Halloran during 
the year. One hundred and fifty-one treatments were given to thirteen patients, 
making an average of 11.62 treatments per patients. 

Employees 

On September 30, 1925, there were 407 persons in the employ of the hospital. 
During the year 522 were appointed, 481 resigned, and 24 were discharged. Nine 
hundred and twenty-nine persons occupied 453 positions, — a rotation of 2.05. 
The average daily number of employees during the year was 425.13, with 5.14 
per cent of vacancies. The average daily number in the ward service was 237.90, 
with 6.31 per cent of vacancies. The ratio of ward employees to patients was one 
to 8.93, and of all employees, one to 5.00. The shortage of employees has continued, 
with a slight improvement during the year. It is diflScult, with a limited number 
of nurses and attendants, to handle satisfactorily the increasingly large number of 
visitors who come to the hospital to see their relatives and friends. We frequently 
have eight or nine hundred visitors in one day, the highest number on any one date 
during the year being 1,057. The decrease in the number of graduate nurses is, 
of course, a material factor in increasing accidents,- injuries and escapes. It is still 
difficult to maintain an adequate force of female nurses and attendants. This is 
due, doubtless, in part, to the fact that the hours of duty are long, and association 
with mental cases is not attractive to those who are not familiar with this line of 
work. However, the general hospitals have also been affected by this problem to 
a certain extent. Under the circumstances, an increase in compensation should 
be seriously considered. One of the factors which has interfered with our main- 
tenance of an adequate force of ward employees heretofore has been the lack of 
comfortable living quarters. At the present time we are unable to properly house 
male attendants. The employees' cottage occupied by men has a capacity of only 
42. Our quota of male attendants is 117. It has been necessary for them to be 
quartered in attics and in many places which are far from being desirable. We are 
badly in need of a new building for male ward attendants. We have no satisfactory 
place for employees engaged in outside work. The old farmhouse in the West 
group, which furnishes quarters for only 19 persons, is in such a condition that it 
should be torn down and replaced as soon as possible. There has always been 
difficulty in inducing our employees to live in it. The fact that our male attendats 
have been scattered around in so many different places has, of course, made it 
difficult to keep them under proper supervision. 

The shortage of staff quarters is also a serious matter which should be remedied 
as soon as the cost of construction will permit. Various officers and employees 
assigned to the East group have from time to time been compelled to live in build- 
ings in the West group, nearly a mile away. 

Medical Service 

There were no changes in the medical staff of the hospital during the year until 
May 1, 1926, when Dr. Franklin I. Flagg, who has been an assistant physician 



14 P.D. 84 

since January 28, 1923, resigned to enter private practice. This vacancy was 
filled on November 1, 1926, by the appointment of Dr. Janice Rafuse as assistant 
physician. Dr. Rafuse is a native of Boston, and was graduated in 1921 from the 
Boston University College of Liberal Arts, receiving the degree of M. D. in 1925 
from the Boston University School of Medicine. She served as interne at the 
Worcester State Hospital during the summer of 1924, and was interne at the 
Metropolitan Hospital on Welfare Island, New York City, from July, 1925, to 
September, 1926. On August 15, 1926, Dr. Anna C. Wellington, senior assistant 
physician, who was appointed assistant physician on October 1, 1925, resigned to 
become Director of the Department of Delinquent Girls, at the Bridgewater State 
Hospital. To fill the vacancy thus created, Dr. Use Lauber was appointed assistant 
physician on November 1, 1926. Dr. Lauber was born in Germany, and took out 
her first papers for citizenship some time ago. She was educated at the Mannheim 
Gymnasium and received her degree of M.D. from the University of Heidelberg 
in 1918. She served as interne at the Mannheim City Hospital for one year, was 
assistant physician for one year at the City Hospital for Insane in Stuttgart, and 
came to this hospital after a service of about six months at the Traverse City 
State Hospital in Michigan. Dr. George H. Maxfield, who was appointed senior 
assistant physician on August 1, 1925, resigned on October 31, 1926, to accept an ! 
appointment on the staff of the Bridgewater State Hospital. This position is 
vacant at the present time. The staff of consulting specialists has remained 
unchanged throughout the year. 

Staff meetings have been held as usual, alternating between the East and West 
groups. Efforts have been made to present all new admissions at these meetings, 
as well as cases about to leave the hospital on visit or cases to be discharged. 

The hospital has been visited regularly by Dr. Irving J. Walker of Boston, who 
has had charge of the surgical work during the year. No cases were sent to the 
Boston City Hospital for operation. The more important operations of the year 
were as follows: Amputation and repair of cervix, 1; Amputation of the breast, 1; | 
Amputation of the toe, 2; Cholecystotomy, 2; Enucleation of cervical glands, 1; i 
Excision of carbuncle from back, 1; Excision of carbuncle from neck, 1; Excision of ! 
epithelioma over right eye, 1; Excision of metatarsal bone, 1; Exploratory laparo- 
tomy, 1; Herniotomy, 2; Incision and drainage, with excision of bone for septic 
foot, 1; Intestinal anastomosis, 1; Mastoid operations, 2; Paracentesis, acute 
otitis media, left, 1; Paracentesis, acute otitis media, right, 2; Peritonsillar abscess, 
1; Removal of hemorrhoids, 1; Repair of fracture, right patella, 1. 

In accordance with the present-day tendency, studies of the newer and more 
promising forms of treatment of neurosyphilis were continued during the past 
year by Dr. Roy D. Halloran. The most noteworthy event was the employment 
of the widely discussed malarial treatment which was given its first real impetus 
by Wagner von Jauregg of Vienna in 1917. In some as yet unexplained manner, 
abrupt and excessive febrile reactions have been followed in from thirty to fifty 
per cent of these cases by a complete or partial remission of symptoms. It is the 
general opinion that this treatment is the most effective thus far introduced. 
Fifteen cases have been under observation. Eight have completed a series of 
paroxysms here and seven received treatment before admission. The first in- 
oculation was given in April, 1926, by transferring 2 c.c. of malarial blood from a 
case under treatment in another hospital to one of our patients. Transference was 
then made from one patient to another after the paroxysms began. Practically 
all patients have gained in weight, some as much as thirty-five pounds, but our 
observations have not been sufficiently prolonged to warrant a definite statement 
as to mental and serological alterations. Three patients are now living at home 
and one is regularly employed. Five appear to have a better grasp on their sur- 
roundings. One, who was deteriorating rapidly, died about two weeks following 
treatment. According to post-mortem findings, this was not in any way attribut- 



P.D. 84 15 

able CO the treatment. In all of these cases quinine arrested the malarial manifesta- 
tions almost at once. Nine of those who have completed the febrile treatment are 
receiving weekly injections of tryparsamide in 3 gram doses, in order that they 
may have the benefit of the most effective specific and non-specific treatments 
combined. Sulpharsphenamine, especially favored for its simplicity of preparation 
and ease of administration, was given to a group of selected cases from July, 1925, 
to March, 1926. Over one hundred and fifty injections in a group of fifteen patients 
were unattended by unfavorable reactions. The venous route was the method of 
choice but it was readily demonstrated that, if necessary, the drug could be in- 
jected without danger into the muscles or into the carotid and brachial arteries. 
Eight cases showed either slight improvement mentally and physically or remained 
stationary. Five continued to deteriorate and two, who were failing rapidly, have 
died since. Serological changes were not consistent in this series of cases. Treat- 
ment was discontinued to permit further investigations with malaria. 

During the development of the treatment of general paralysis by drug injections 
into the carotid artery, in 1924 and 1925, the possibility of obtaining blood directly 
from the brain for the study of its metabolism in health and disease was suggested. 
Thorough examinations of the anatomy of the neck showed that the internal jug- 
ular vein could be punctured with a needle at a point just below and slightly 
inside of the mastoid tip. Here the blood from the brain is not as yet mixed with 
that of the body. By moving the needle on the skin about one-quarter of an inch 
inside the point mentioned, the internal carotid artery can also be entered. The 
comparison of the blood entering with that leaving the brain might logically lead 
to some information as to what usage the brain makes of the food supply furnished, 
and possibly reveal what new products may be there elaborated as far as limit- 
ations of biochemical examination will permit. With this idea in mind, nine 
sets of specimens from several patients were readily obtained from the internal 
carotid artery, the internal jugular vein, and a large vein in the arm. A specimen 
of the spinal fluid was also obtained. The specimens from the arm and the spinal 
fluid were to be used for more complete comparisons, the spinal fluid forming 
the only other connection with the brain. Special tests for urea nitrogen, non- 
protein nitrogen, sugar, calcium, phorphorus, and carbon dioxide determination 
were made. In a few cases the oxygen tension was determined. Because of the 
difficulties in securing adequate laboratory examinations investigation was tem- 
porarily discontinued before even a working routine could be established. It is 
expected that this will be completed at a later date. A description of the tech- 
nique for obtaining blood from the internal jugular vein and internal carotid 
artery is to appear in the " Archives of Neurology and Psychiatry. " This work 
was all done by Dr. Roy D. Halloran in conjunction with Dr. A. Myerson and 
Dr. Henry L. Hirsch. 

A special study was made during the year to determine as far as possible the 
part played by the processes of involution in the production of mental disorders 
(Bulletin, Massachusetts Department of Mental Diseases, Volume 10, Nos. 1 
and 2, April, 1926). For this purpose a review has been made of 2,534 consecutive 
first admissions. Of this number, 892, or 35.2 per cent, were found to have had a 
definite onset between the ages of forty and sixty. An analysis of these cases 
shows that 3.3 per cent of them had definite paranoid states, 3.25 per cent, 
schizophrenic episodes, .68 per cent, single attacks of excitement, and 3.47 per 
cent, genuine involution melancholia as described originally by Kraepelin. As a 
result of this study, the following conclusions would seem to be warranted: 

1. There is a considerable number of paranoid conditions, more common 
in women, characterized by hallucinations of hearing and delusions of per- 
secution and developing between the ages of forty and sixty, not attributable 
to alcoholism, ateriosclerosis or senility, and obviously not related to dementia 
praecox. 

2. There is an equally large number of schizophrenic conditions, more 



16 P.D. 84 

common in women, and appearing for the first time during the involution 
period of life in individuals who have never before shown anything suggesting 
dementia praecox. 

3. Involution melancholia as a clinical entity would appear to be thoroughly 
justified and clearly separable from the manic-depressive group by the ex- 
hibition of a symptom-complex which presents itself only during the involution 
period. 

4. Single attacks of excitement appearing for the first time during the 
involution period are rare and may be of somatic origin. 

5. While these manifestations are in many instances probably exaggerations 
of latent tendencies peculiar to the makeup of the individual, a constitutional 
basis for these conditions is not yet clearly established. 

6. We would appear to be justified in the formulation of the hypothesis 
that there is a well-defined clinical group of Involution Psychoses including 
all of the types already enumerated and almost certainly others, to be de- 
termined by further investigations. 

7. This group may be defined as including the following: 

1. Manic Types. 

2. Involution Melancholia. 

3. Other forms of Depression. 

4. Paranoid Types. 

5. Schizophrenic Types. 

6. Presenile Types (Alzheimer's Disease). 

7. Other types (to be specified). 

Out-Patient Service 
The supervision of patients in family care and those on visit, as well as the after 
care of cases discharged from the custody of the hospital, is an important part of 
the work of the out-patient department. Medical advice is given to many persons 
who come to the hospital to consult members of the staff on matters concerning 
their own welfare or that of their family or relatives. Frequent visits are made by 
the social workers to patients who have been allowed to go home or who have left 
the hospital temporarily for family care. Patients on visit are also required to 
report at the hospital at regular intervals for observation. Many former patients 
who have been discharged are kept under the supervision of our social workers and 
physicians. Some cases which appear for consultation are referred to their family 
physicians or to the Boston Psychopathic Hospital. The following table shows the 
movement of patients under the supervision of the out-patient department: 

Males Females Totals 



In family care September 3.0, 1925 10 10 

On visit September 30, 1925 96 175 271 

On escape September 30, 1925 I3 1 14 

On visit from family care September 30, 1925 2 2 

Dismissed to family care during the year 4 4 

Dismissed on visit during the year.... 753 430 1233 

Escaped during the year 11 2 13 

Admitted from family care during the year.... 7 7 

Admitted from visit during the year 671 395 1066 

Admitted from escape during the year 15 15 

Admitted from family care and discharged 

Admitted from visit and discharged 73 139 212 

Admitted from escape and discharged 7 7 

Admitted from visit from family care 11 

Admitted from visit from family care and discharged 11 

In family care September 30, 1926 7 7 



P.D. 84 17 

On visit September 30, 1926 105 121 226 

On escape September 30, 1926 2 3 5 

On visit from family care September 30, 1926 

Social Service Department 
The following is a summary of the social service work done during the year: 

Total number of cases considered 802 

New cases, Hospital 244 

New cases, School clinic 268 

New cases, community 4 

Renewed cases from previous year 87 

Continued cases from previous year 199 

Closed cases during the year: 

Hospital 478 

School clinic 233 

Community ' 2 

Cases continued 794 

Sources of new cases: 
Referred by physicians: 

Hospital 358 

School 313 

Referred by community agencies 47 

Rerred by friends or relatives 4 

Refef erred by initiative of patients. 2 

Selected by Social Service 12 

Purposes for which cases were referred: 
Histories: 

Hospital patients 68 

School clinic cases 313 

Investigation: 

Conduct disorders 48 

Employment situations 21 

Home conditions 183 

Statements of patients 46 

Statements of others 34 

Full social investigations 64 

Court investigations 12 

Supervision: 

In home 188 

In industry 18 

In community 78 

Care of patients' families 31 

Personal services 91 

Placement 26 

For medical care 3 

Ex-service investigations 16 

To care for property 2 

Abstracts sent on 54 

Location of relatives 46 

Problems in all cases: 
Disease: 

Mental 684 

Physical 139 

Sex problems: 

Promiscuity 6 



IS P.D. 84 

Wayward tendencies 45 

Assault 3 

Environment: 

Financial difficulties 11 

Employment difficulties 42 

Unsuitable surroundings 25 

Friction (family 27; others 3) 30 

Marital difficulties 24 

Personality problems: 

Temperament 33 

Anti-social habits 11 

Vacillating interests 23 

Educational problems: 

Readjustment of habits of mind 137 

Recreation, — church; social relationships 86 

Legal problems: 

Concerning property or support 45 

Resulting from conduct of patient 35 

General problems: 

Family and children 49 

Friendlessness 10 

School 108 

Miscellaneous 62 

Nature of service rendered: 
Medical: 

Information relating to school history 313 

Information relating to medical history 376 

Information relating to home conditions 252 

Information relating to condition of out-patients 216 

Arrangement for medical assistance 49 

Social: 

Adjustments for patients: 

Environment 56 

Personal relations 45 

In industry 15 

In recreation 27 

Ad\'ice to relatives 160 

Advice to patients 129 

Advice to others 32 

Connecting with agencies 153 

Connecting with indi\dduals 77 

Family assistance: 

Legal 14 

Financial 10 

Miscellaneous 14 

Arrangements for further study or training 14 

Personal services 142 

Placement work: 

Home ^ 13 

Industry 8 

Abstracts sent on 54 

Relatives located 46 

Total number of visits 2,179 

To patients on ward 176 

To patients on visit 557 



P.D. 84 

To relatives or friends. 

To social agencies 

To others 



19 

632 
420 
394 



I regret to report the resignation, on December 31, 1925, of Miss Marie L. 
Donohoe, head social worker, who left the State hospital service to become the 
mental health worker with the Community Health Association in Boston. Miss 
Donohoe, was appointed head social worker at this hospital on July 9, 1917, and 
for over eight years her first interest was the building up and development of the 
social service department. She possessed unusual personal qualifications for this 
work, and to her untiring enthusiasm and energy is due its present high standard. 
She was also very successful in training the students who came to the hospital 
from the schools for social service work, and many of those whom she has trained 
are now holding responsible positions in social work throughout the country. On 
January 1st Mrs. Louise T. MacNamara, social worker, assumed charge of the 
department and directed the work until the appointment of Miss Florence E. 
Armstrong as head social worker on May 10, 1926. Miss Armstrong was born 
and educated in Boston, was graduated from Radcliffe College in 1914, and has 
also had special training at the summer session of the Smith College School for 
Social Work. She was engaged for m.any years in work with the problem girl, 
in Boston and in Washington, D. C, for one year was supervisor for the State 
Bureau of Child Welfare in Connecticut, and at the time of her appointment here 
was connected with the Habit Clinic of the Springfield Hospital. During the year 
one social worker resigned, and the vacancy thus created was filled by the pro- 
motion of the assistant social worker. A graduate of the Smith College School 
for Social Work was appointed assistant social worker. The department continues 
to benefit by the services of students, who are, in return, receiving training and 
supervision in psychiatric case work. There are several new directions in which 
the department may extend its work, thereby rendering greater and more efficient 
service to the hospital. There is at present in the hospital a large number of 
patients who cannot go out into the community without the most careful prepara- 
tion and subsequent supervision. Their placement, however, would relieve the 
State of considerable expense. The investigations, educational work, and super- 
vision thus entailed would make an increased staff a necessity. 



The following is a summary of the routine work of the pathological laboratory: 
Autopsies, 38; Blood examinations: Cell counts, red, 56; Cell counts, white, 55; 
Cell counts, differential, 50; Hemoglobin estimation, 56; Bacteriological examina- 
tions, 35; Examinations of feces, 2; Sputum examinations, 29; Throat cultures, 2; 
Urinalyses, 993. 

As we have been without a pathologist during the year, we are still indebted 
to Dr. Marjcrie Fulstow, pathologist to the Department of Mental Diseases, for 
autopsy work at the hospital. 

The number of deaths in the hospital during the year was 326, of which 38 came 
to autopsy, making the autopsy percentage 11.66 for the year. 

The following were the psychoses in the cases coming to autopsy: Senile 
psychoses, 7; Psychoses with cerebral arteriosclerosis, 14; General paralysis, 5; 
psychoses with other brain or nervous diseases, 2; Alcoholic psychoses, 2; Psychoses 
with other somatic diseases, 3; Manic-depressive psychosis, 1; Dementia praecox, 
2; Psychoses with mental deficiency, 2. 

The causes of death were as follows: Abscess of lung, 1; Aortitis of the specific 
type, with hypertrophy of heart and thrombi of left auricle wall, 1; Arterio- 
sclerosis, 12; Bronchopneumonia, 6; Carcinoma of the sigmoid colon, with stricture 



Pathological Laboratory 



20 P.D. 84 

of the intestine, 1; Cerebral thrombosis and hemorrhage, 1; Cystitis, acute and 
chronic, 1; Enteritis, acute, 1; Gangrene of lung, 1; General paralysis, 3; Interstitial 
obstruction, chronic, 1; Lobar pneumonia, 2; Myocarditis, acute, 2; Pulmonary 
tuberculosis, 2; Pyelitis, chronic, 1; Rupture of aortic aneurysm, 1; Tuberculosis 
of cecum, 1. 

Dentistry 

The following work has been carried on during the year by Dr. Martin P. Rose, 
the resident dentist: Alveolotomies, 11; prophylaxis, 225; Curettements, 142; 
Examinations, 1269; Extractions, 1960; Fillings, 378; Medicinal treatments, 490; 
Patients treated, 1943; Removals of benign growth, 2; Restorations, 68; Sutures, 
92; Facial inflammatory iodoform gauze drains, 38. Every patient is given a 
thorough examination by the dentist at least twice during the year. Any conditions 
requiring treatment are noted on the dental charts, and patients given such at- 
tention as may be found necessary. The administration of novocain suprarenin 
has been resorted to on numerous occasions and it has been necessary to use ether 
in a considerable number of instances where the use of a local anesthetic was 
contraindicated. 

Hydrotherapy 

On December 1, 1925, Miss Frances N. O'Regan was appointed hydrotherapist 
to fill the vacancy caused by the resignation of Mrs. Helena B. Hubbard, and on 
August 19, 1926, a male hydrotherapist, Mr. Perley M. Silver, was added to the 
staff. During the year 3,805 packs and 5,119 continuous baths were given, making 
the average daily number of packs 10.43 and the average daily number of con- 
tinuous baths 14.03. The following treatments were also given during the last 
nine months of the year: salt glows, 666; hair shampoos, 709; tub shampoos, 495; 
Swedish shampoos, 372; hot and cold to spine, 533; vapor baths, 161; Sitz baths, 
322; foot baths, 597; saline baths, 380 pail douches, 2; wet mitten friction, 2; 
needle sprays, 3,771 ; and fan douches, 3,737. The patients treated had the following 
psychoses: general paralysis, 4; alcoholic psychoses, 3; psychoses with other 
somatic diseases, 4; manic-depressive psychoses, 144; involution melancholia, 2; 
dementia praecox, 107; paranoia or paranoid condition, 1; psychoses with psycho- 
pathic personality, 24; psychoses with mental deficiency, 6; and undiagnosed 
psychoses, 10. 

School Clinic 

The Mental Clinic in Public Schools, as provided for by act of the General Court, 
Chapter 277, 1919, completed its fifth session in June, 1926, under the direction 
of Dr. Alberta S. Guibord. Three hundred and fifty-five pupils were examined 
during the school year. As a result of the intelligence test employed they were 
classified as follows: Superior Normal (I.Q. 110), 1; Normal (I.Q. 90-109), 22; 
Dull Normal (I.Q. 80-89), 65; Borderline (I.Q. 70-79), 126; Feebleminded, upper 
range (I.Q. 50-59), 92, lower range (I.Q. 30-49), 11, total Feebleminded, 103; 
Undiagnosed (need further study), 38. An immense amount of work goes into 
the examination and study of these pupils. It involves the services of a psychiatrist, 
a psychologist, and social workers, all provided by the hospital; a teacher from the 
local schools, specially trained for school testing; and the additional service of the 
school principal and teachers in conferring about the cases. The average time 
spent on each pupil is four hours. If an equivalent study were sought from private 
specialists, the cost would be considerable. In view of the amount of work involved, 
it is natural to inquire how the recommendations have been carried out. Those 
that apply strictly to the school curriculum are utilized quite generally. Pupils 
are being graded more and more according to mental age. The curriculum is 
being gradually broadened to meet the practical needs of pupils whose academic 
limit is sixth grade or less, i.e., feebleminded and borderline cases. The recom- 
mendations that apply to physical handicaps are also being carried out more 
effectively each year. Those that apply to the management of pupils with psycho- 



P.D. 84 21 

neuiotic traits, delinquent tendencies or unfavorable social influences receive 
little attention. The schools do not yet, to any extent, understand these problems, 
and, even if they did, have no one, such as a \'isiting teacher, to handle them. 
The School Clinic will not reach its fullest usefulness until the schools have some- 
one to carry on this particular phase of the work. 

Training School for Nurses 
There are now employed in the wards of the institution eleven of our own 
graduates. One of the most important objects of the nurses' training schools is 
the instruction of employees who are to care for the patients in our wards, although 
it is also desirable to graduate nurses who are qualified to care for psychiatric 
cases in the community. It is becoming more difficult, however, to maintain 
training schools for nurses in the State hospitals. There are now no pupils in our 
training school and no applications are being received from those who meet the 
minimum entrance requirements. Graduate nurses find work in other fields of 
nursing more attractive as well as more remunerative, and there is continued 
difficulty in retaining our own graduates, many of whom leave the service soon 
after the completion of their training to accept positions which are more profitable 
financially. If the standards of our hospitals are to be maintained, we must have 
more graduate nurses. To accomplish this, it will be necessary to offer a higher 
rate of pay to graduate and charge nurses. The systematic instruction of at- 
tendants, both male and female, is being carried on along the lines prescribed by 
the committee on training schools, representing the Department of Mental Diseases. 

Occupations and Industries 

The work of the Occupational Therapy department during the year has been 
carried on under the direction of Miss Clara H. Offutt. Of the 1,011 patients who 
have come under the supervision of this department, 84 have improved enough to 
be allowed to go home; 30 more benefitted sufficiently to be capable of working in 
industrial departments; 3 were transferred to other hospitals and 23 died. The 
average daily number occupied in male wards was 103 and in the female wards, 251, 
making a total daily average of 354. The highest number occupied on any one 
day was 524. The authorized personnel of this department remains as last year — 
one head therapist and eight assistants. There are also four attendants assigned' 
for duty from time to time. Six graduates from the Boston School of Occupational 
Therapy have each had one month of practical experience and training and in 
October the entire class, with an instructor, visited our department. Classes 
are conducted in all buildings, male and female, except West D, where patients 
are doing industrial work. The morning class in the West F basement, which was 
started last year, has quite outgrown its quarters. Many patients ask to be taken 
down who cannot be accommodated. In the afternoon these patients are given 
work on the wards. In the West G Building, the acute and disturbed service for 
men, the classes have grown in numbers and interest during the past year. The 
men respond with enthusiasm, turn out good work and show a remarkable insight 
into and appreciation of the therapeutic value of the work. On the disturbed ward, 
one man who was destructive, quarrelsome, and difficult to manage has become 
so interested in weaving quaint and curious designs that these former tendencies 
have disappeared and he is quite happy in his work. The work for women consists 
of basketry, weaving, rug making, sewing, needle work, knitting, crocheting, rake 
knitting and braiding. For men, wea\ang, woodwork, basketry, bookbinding, 
and rake knitting are the crafts which interest them most. 

The "occupational therapy center for mental patients" at Hopkinton has come 
through another year, proving that it is an established institution. There has 
been no notable change in the number of patients aided here and outwardly the 
work appears unchanged. Following the resignation of Miss Donohoe as head 



22 P.D. 84 

social worker, her activities in connection with the center were necessarily reduced. 
At the end of six months under these conditions, her successor taking over the 
work found signs of vigorous life. In the interval the patients had been in the 
charge of a full time occupational therapist. Their physical and mental health 
has been improved and the output of work excellent enough to sell. Some have 
remained throughout the year and others have gone out into the commiunty. 
During the year several have returned to the center for brief periods when there 
was a pcssibility of recurrence of an episode, thereby saving themselves real 
mental illness and a hospital residence. New patients have been admitted. It is 
the aim of the committee in charge of the center to accept only such patients as 
it is believed will be able to return to the community after a period varying between 
a few weeks and a year. It is not a home for chronic patients. The Permanent 
Charity Fund has repeated its gift of $500 for the coming year. This amount 
forms the largest part of a fund which is drawn upon to supplement the board of 
patients who are unable to pay for their care, and to advance money for purchasing 
new supplies. It is highly important to greatly increase this fund, in order that 
the growth of the work may not be restricted. Mrs. L. Vernon Briggs is giving 
inestimable support in paying the salary of a full time worker, and she also con- 
tributes generously of her interest and enthusiasm. It is the belief of those most 
closely connected with this enterprise that there are great possibilities of future 
growth and service. The work of the Center is in charge of a committee made up 
of the following members: Mrs. L. Vernon Briggs, Mrs. Sydney Dreyfus, Mrs. 
Horace Morrison, and Mr. William F. Whittemore, Treasurer. The Chairman 
is the head social worker of the hospital. 

The work of the industrial room for women has been carried on under the 
continued direction of Miss Madge B. Lytell. This consists of basketry, rug 
making, weaving, lace making, embroidery, knitting, crocheting, sewing, mending, 
etc. The estimated value of the articles produced in this department during the 
year was $10,639.81. The industrial work for men has been carried on under the 
direction of Mr. James F. Hurley. This is done entirely in the basement of the 
B building in the West group, and includes shoe repairing and various other repair 
work, the manufacture of several different kinds of brushes, brooms, coat hangers, 
hats and numerous other articles. The value of the articles produced during the 
year is estimated at $8,004.65. The articles produced in the occupational and 
industrial departments in the hospital for the year represented a total valuation 
of $24,344.37. 

Agricultural Activities for the Year 
On February 7, 1926, Mr. Laurence J. Olsen resigned as head farmer and was 
succeeded on April 1st by Mr. James V. David, who has had charge of the farm 
since that time. A total of 138 acres was under cultivation. This consisted of 47 
acres devoted to gardening, in addition to 87 acres of meadowland and 4 acres 
of orchards and small fruits. The estimated value of farm products for the year 
was $19,629.10 

Financial Statement 
The maintenance appropriation for the year was $780,235.00, which was supple- 
mented by $4,000.00. In addition to this, $11,562.56, brought forward from the 
preceding year, and $8.85, transferred from small items, made the total $795,806.41. 



P.D. 84 



23 



Amount Per Percentage 

Expended Capita Of Total 

Personal Services $368,453.30 $172,788 48.578 

Travel, transportation and office expenses 6,837 .44 3 . 207 . 901 

Food 190,025.28 89.114 25.054 

Clothing and materials 29,965.29 14.053 3.951 

Furnishings and household supplies 44,705 .60 20 . 965 5 . 890 

Medical and general care 27,120.13 12.718 3.575 

Religious Instruction 2,079.98 .975 .274 

Heat, light and power 53,646 .88 25 . 159 7 . 073 

Farm 5,752.17 2.699 .758 

Garage, stable and grounds 6,942.24 3.256 .915 

Repairs, ordianry 15,049.13 7.058 1.984 

Repairs and renewals 7,939.83 3.724 1-074 

Total $758,517.27 $355,716 100.000 



Based on the average daily population of the hospital (2132.40), the per capita 
cost of maintenance for the year was $355,716, or $6.8405 per week. The per 
capita cost for the year 1925 was $350.73, or $6.7448 per week. An important 
factor in keeping up the cost of maintenance is the type of patients cared for in 
this institution, about one-third of the population being of the infirmary class, 
with a large percentage of bed patients. The absence of a dairy and the lack 
of agricultural facilities are serious considerations. Owing to the fact that our 
old ward buildings are made up of small units and consist largely of single rooms, 
a greater number of employees and more supervision are required than would be 
necessary in buildings of another type where only custodial care is needed. No 
buildings designed for purely custodial patients in considerable numbers have 
ever been erected at this institution. The cost of maintaining the old buildings 
erected many years ago by the City of Boston increases every year. 

General Operations for the Year 

The hospital was visited as usual during the year by the Commissioner of Mental 
Diseases and his various representatives, as well as by the Lieutenant Governor 
and the Executive Council, and the Commission on Administration and Finance. 

A review of the general operations of the hospital for the year is largely a brief 
summary of our efforts towards keeping our various buildings in repair, as far as 
has been consistent with the funds available, and maintaining the standards of 
the hospital. 

Entertainments for patients have been provided at frequent intervals as usual. 
A very successful and interesting concert was presented at the East Group chapel 
by the Boston Philharmonic Ensemble on December 24, 1925. Either dances 
or motion picture shows were available for our patients every week during the winter 
season. 

Religious services, both Protestant and Roman Catholic, have been held every 
Sunday throughout the year, and the wards have been visited regularly by the 
Jewish rabbi. 

As the result of an appropriation rendered available by Chapter 347 of the Acts 
of 1925, the sum of $18,000 has been set aside by the Department of Mental Diseases 
for the purpose of fire prevention at this institution. Owing to the limited amount 
of funds at our disposal for this purpose, it was necessary for the hospital to furnish 
all the labor involved. The following work was done at the request of the De- 
partment: 

Fireproof partitions were installed in the stairways of the East A Building; 

Automatic closing fire doors were placed in the corridors leading to the East 
Group chapel and the East B and C Buildings; 

Fire doors were installed in the connecting corridors of the East B Building 
and its vertical shaftways, the stairways and dumb waiters of the East C Building, 
connecting corridors and dumb waiter shafts in the East D Building, the base- 
ment corridors and dumb waiters of the East E Building, the dumb waiters in 



24 P.D. 84 

the East F Building, and the stairways in the East G Building; 

One additional hydrant has been installed in the vicinity of the East nurses* 
home, and another was installed in front of the storehouse; 

Additional standpipes have been pro\'ided for the paint shop and 

Additional hose has been placed in the basement of the storehouse. 
The old class room in the basement of the East C Building was remodelled during 
the winter and is now being used for staflf meetings. 

During the year painting has been completed on the various buildings as follows: 

East Group administration building both exterior and interior; 

West C Building, interior; 

West G Building, interior painted by patients, with the exception of the 
stairways, which will have to be done later; 

Corridors, interior, between the administration building and C Building in 
the West Group, done by patients; 

Interior of El and E2 in the West Group, also done by patients; 

The woodwork on the exterior of the West B Building; 

Some of the outside window guards; 

The exterior of the West Kitchen and Dining Room Building. 

In addition to the above, painting operations were well under way in the West 
A Building at the end of the fiscal year. Owing to the limited number of painters 
at our disposal, it is not possible to keep up the appearance of our buildings in 
the way that we would like. We are also seriously handicapped by not ha\ang 
an adequate force of plumbers, steamfitters, and masons. 

The maintenance appropriation for the year made available $600 for the purchase 
of window guards for the East B Building. Thirteen have been bought and in- 
stalled and seven more are needed to complete the work. 

Seven hundred and twenty-seven dollars were made available for the purchase 
of radio equipment, which has been bought and will be installed as soon as possible 
in the buildings of the West Group. Five hundred dollars were also expended in 
providing additional seating capacity for the West Group chapel. 

During the year $4,000 was spent for food containers. We now have enough 
insulated boxes to insure the delivery of hot food supplies in all of the buildings 
where the patients are served at the present time outside of the Kitchen and 
Dining Room Buildings, with the exception of the congregate dining room in the 
West F Building, for which boxes of a special size will have to be made. 

A hood was bought for the range in the West Group kitchen during the winter. 

The grading operations between the West Group Kitchen and Dining Room 
Building and the F Building were completed during the summer and the resulting 
lawn at that place has made a material improvement in the appearance of the 
Group. 

The copper flashing on the chimneys of the West Group Kitchen and Dining 
Room Building was reset during the year and the roofs of that building are now 
waterproof. 

All of the ovens in what was formerly the bakery in the storeroom building 
have been removed, the room has been refinished and is now available for storage 
purposes. 

New concrete steps were installed at the two front entrances of the administration 
building in the East Group. 

A cement walk was laid at the West Group extending from the south end of 
the Kitchen and Dining Room Building to the rear entrance of the same building. 

New doors were installed at the lower entrance of the laundry building. 

It is a pleasure to be able to report that the channel of the Canterbury Branch 
of Stony Brook was cleaned out thoroughly by the City during the summer of 1926. 

Another interesting piece of work was the widening of Morton Street by the 
removal of a considerable portion of a hill on the hospital property at the junction 



P.D. 84 25 
cf that street with Canterbury. This was done in connection with the repavement 
of Morton Street from Canterbury Street to the entrance of Forest Hills Cemetery. 

The work of filling in the land in the rear of the East Group buildings was 
completed during the year and we are now engaged in similar operations on the 
area immediately west of Morton Street and north of the brook. The material 
used has been contributed by the contractors who remove ashes from the Dorchester 
District, as well as by various others. 

The Fire Menace 
Reference should be made once more to the urgent necessity of giving serious 

consideration to the recommendations made by the Board of Trustees of this 

hospital last year, as follows: 

"That attention be again called to the necessity of 

•"1. Remo\ing the old wooden administration building in the East Group, 
constituting as it does a distinct fire menace as a result of the existence of 
wooden stairways running from the basement to the attic, the presence of 
exposed electric wires and wires in wooden conduits in various parts of the 
building, and the necessity of housing a considerable number of persons in 
the attic, — a place where their lives would certainly be placed in jeopardy by 
a serious fire; 

"2. Pro\iding for the removal of the old barn located a few hundred yards 
from the Administration building above referred to, and containing a large 
amount of hay; 

"3. Remo\-ing the other wooden buildings and sheds in this same neighbor- 
hood; 

"4. Installing sprinklers and such other fire protection as may be needed 
to insure the safety of the six hundred and more patients in the old non-fireproof 
stucco buildings until such time as these buildings can be replaced by fire- 
proof structures; 

"5. Remo™g the old wooden farm building located in the West Group 
and housing in the neighborhood of twenty employees, the Building In- 
spector for the Department of Public Safety ha\'ing refused to certify this 
structure for occupancy; 

'"6. The prompt adoption of such other measures for fire protection as may 
be deemed necessary by the proper authorities."' 

In connection with these suggestions, attention is again called to the following 
quotations from the recommendations made by the Fire Commissioner of the City 
of Boston: "That all the old buildings, wooden and stucco covered, should be 
demolished and buildings of 1st class fireproof construction be erected in their 
stead."'* * * * These recommendations, which may appear extensive, are 
an urgent necessity and based on the nature of the occupancy, and the character 
of the construction which is hardly fit for persons of normal physical and mental 
condition."' "We have been very fortunate so far in escaping any serious con- 
flagrations or any fires accompanied by loss of life owing to building conditions 
which are indefensible. It is worthy of note that over six hundred patients are 
being housed in the old stucco buildings the removal of which was considered 
very important by the Fire Commissioner of the city. Reference should also be 
made to the fact that eighty-six employees are now li\ing in the attics of our various 
wooden and stucco buildings, in places which are not only highly undesirable but 
unsafe. These buildings should unquestionably be replaced by fireproof structures. 
They cannot be rendered safe by any additional fire escapes or even sprinklers, 
the use of which is out of the question in day rooms and dormitories occupied by 
patients. The following recommendations relating to fire prevention at the 
hospital were received from the Department during the year: 

"1. That the use of basement and attic of the East A Building for storage 



26 P.D. 8-4 

be discontinued; 

•'2. That the use of the West B Building basement for industrial or storage 
purposes be discontinued; 

••3. That the use of the attic of the West C Building for storage and the 
use of any part of the building for industrial purposes be discontinued; 

"4. That the use of the basement of the West D Building for shop purposes 
be discontinued; 

"5. That the use of any part of the basement of the West F building for 
shops or storage purposes be discontinued."' 

A letter has been filed with the Department showing that it is not possible for 
us to discontinue the use of these attics and basements for storage and industrial 
purposes until additional buildings can be pro\'ided for the purposes specified. 

Canterbury Branch of Stony Brook 
Chapter 33 of the Resolves of 1925 made pro\'ision for the appointment of a 
Special Commission to Investigate the Necessity' for the Construction of a Covered 
Channel to Accommodate the Waters of the Canterbury Branch of Stony Brook 
in the City of Boston. A report of this commission was filed under date of December 
12, 1925. Their findings are so important and have such a material bearing on the 
future welfare of the hospital and its development that it has been thought worth 
while to call attention to the following extract from their official report as set 
forth in full in House Document No. 323: 

"House Bill 300 resulted from the complaints of officials of the Department of 
Mental Diseases that floodings of the property of the Boston State Hospital for 
mental defectives in West Roxbury, due to the existing open channel of Canterbury 
Branch of Stony Brook, preclude the erection of additional buildings, put out of 
commission at times a steam conduit line, and prevent the use of about 35 acres 
of fertile farm land for any purpose except an uncertain crop of hay. Due to the 
unprecedented flood conditions brought about by two unusually heavy rainfalls 
in late August and early September, 1924, permanent relief from a recurrence of 
these conditions should be considered. 

'"The Hospital property is bounded by Canterbur>% Austin, Harvard and Walk 
Hill streets, and comprises approximately 233 acres di\ided into two parts by 
Morton Street. The easterly part, comprising about 47 acres, has one group of 
buildings which includes the power and heating plant. The westerly part has about 
186 acres with a second group of buildings located near Walk Hill Street to which 
steam is supplied from the power plant of the East Group. 

''This Hospital was formerly owTied and administered by the city of Boston for 
its insane patients and the two groups of buildings were known, respectively, as 
Austin and Pierce farms. The institution was turned over to the State in 1908. 
At present, it is stated by the superintendent of the Hospital that only 46 per cent 
of the insane from the city of Boston are cared for at this Hospital, the remainder 
being sent to other State hospitals. 

"Stony Brook and Canterbury Branch" 
" The Canterbury Branch of Stony Brook carries the surface drainage from a 
large part of Dorchester in a covered conduit ending at Harvard Street at the 
Hospital grounds, and thence traverses the grounds in an open channel. The 
section from Harvard Street to Asylum Road has a wooden box invert and sloping 
riprap sides, and the section from Asylum Road to Stony Brook is a channel in 
the natural soil. There are deposits at present in the entire length of the open 
channel which reduce the original carrying capacity during flood periods perhaps 
50 per cent. The total length of the open channel from Harvard Street to Stony 
Brook is approximately 5,800 feet, of which approximately 3,600 feet are within 
the Hospital grounds. 



i 

P.D. 84 27 

"Stony Brook is at present a covered channel from the Back Bay Fens up to 
Toll Gate Road, near Forest Hills, and up stream from that point through West 
Roxbury and Hyde Park is an open brook. From Toll Gate Road to the junction 
of Canterbury Branch is approximately 3,600 feet. 

"During heavy rainfalls there are extensive flooded areas adjacent to the open 
channels of Stony Brook and its tributaries which have been decreased as the 
covered section of Stony Brook was gradually extended up stream. These periodic 
floodings are the cause of frequent and justifiable complaints, and they have also 
retarded building development in otherwise desirable neighborhoods. The building 
of suitable covered conduits for these open channels would practically eliminate 
complaints, stimulate building, and increase taxable values along their valleys. 

''Hydraulic Conditions 

"The improvement of Stony Brook has thus far been carried out in accordance 
with the recommendations of the Stony Brook Commission in 1886 (Boston City 
Document 159 of 1886), and the Stony Brook channel, as already stated, has 
been completed as far as Toll Gate Road, at Forest Hills. 

"In order that the flooding of the Hospital grounds between Walk Hill Street 
and Harvard Street may be wholly relieved, it will be essential, first, to extend 
the covered channel of Stony Brook and the channel of Canterbury Branch to 
Walk Hill Street. 

"The original plan of the Stony Brook Commission contemplated a diversion 
of the waters of Stony Brook and Canterbury Branch from their junction through 
a tunnel into the Neponset River at the Milton Lower Mills, after the capacity 
of the main channel of Stony Brook below this junction has been reached. It will 
probably be many years before this diversion will be necessary. By maintaining 
the present open channel of Canterbury Branch in proper condition above Walk 
Hill Street, a covered channel between these limits can be omitted for many years, 
or until the deep tunnel to the Neponset River is necessary. 

"The hydraulic conditions established by the Commission of 1886 provide for 
the invert of Canterbury Branch from Stony Brook to Morton Street, being so 
far below the present open channels of both Canterbury Branch and Stony Brook 
that it would be impossible to build this section at present in accordance with the 
proposed future construction, and give any relief to flood conditions at the State 
hospital. In fact, the bottom of the proposed covered channel for Canterbury 
Branch between the main Stony Brook and Morton Street, as recommended in 
the report of 1886, is from 12.34 feet to 17.49 feet lower than the present bottom 
of the existing open channel. 

"While the open channel of Canterbury Branch is now restricted by a deposit 
which reduces its carrying capacity, which should unquestionably, in our opinion, 
be dredged out, the flooding of the Hospital grounds is due both to the deposits 
in the open channel in the Hospital grounds and also to the inadequate capacity 
of the present open channels of Canterbury Branch and Stony Brook from Walk 
Hill Street to Toll Gate Road. Hence, any permanent relief from the flooding of 
the Hospital grounds should begin with Stony Brook by continuing its covered 
conduit up stream from Toll Gate Road. 

"Financial 

*'The total approximate cost of providing covered channels for Stony Brook 
from Toll Gate Road to Canterbury Branch, and for Canterbury Branch from 
Stony Brook to the lower end of the present covered channel at Harvard Street, 
is $1,353,000, of which $832,000 represents the cost of the covered channel as far 
as Walk Hill Street at the lower end of the Hospital grounds, the cost of the 
section through the Hospital grounds being $471,000. 

"Recommendations 
"We recommend the following program: 



28 PD. 84 

"1. The progressive construction, under existing statutes, of covered channels 
of Stony Brook and its tributaries, year by year, until the flooded areas are relieved. 

"2. Remove as frequently as required the deposits in the open channel of Canter- 
bury Branch from Walk Hill Street to Harvard Street. 

"We have considered the question of the necessity for new legislation for carrying 
out the improvements recommended, but find that the city of Boston has ample 
powers to do this work under existing legislation." 

The correction of the conditions which were found by the Commission as shown 
in the above is a matter of such great importance that it should merit further 
consideration. 

The Future Development of the Hospital 
In \aew of the necessity for additional accommodations for the insane of the 
City of Boston, the question as to the future development of this hospital is one 
of great importance. Its expansion must necessarily depend upon two factors: 
(1) the policy of the Department of Mental Diseases as to the maximum size 
considered desirable for hospitals for mental diseases in this State, and (2) upon 
the present capacity of the institution. A survey has been made recently, at the 
request of the Department, for the purpose of determining the floor space available 
for patients in our ward buildings. It was found that we have a total of 178,847 
square feet in our sixteen buildings occupied by patients, this space being divided 
as follows: bed space available in dormitories, single rooms, etc., 124,629 square 
feet; and day room space, 54,218 square feet. The question reamains as to how 
many patients can be furnished adequate accommodations in the space available. 
The only ruling in this State on this subject at the present time is to be found in 
the Seventh Annual Report of the State Board of Insanity, for the year 1905. 
It reads as follows: "After careful consideration, the following unit of floor area 
has been adopted: 50 square feet per patient in day rooms, an equal amount in 
dormitories, and 100 square feet in rooms used continuously by the sick in bed or 
other classes, with the exception that in colony buildings, where the patients are 
all quiet, clean, able-bodied and out of doors most of the day, the day space has 
been reduced to 30 square feet." If 50 square feet of floor space per patient in 
dormitories and 50 square feet per patient in day rooms, a total of 100 square feet, 
is accepted as the unit of capacity, the Boston State Hospital has at this time 
accommodations for only 1,788 patients. Based on our present population or any 
number approximating that, this means an overcrowding of over twenty per cent, 
a condition of affairs which should be remedied. If, as has been suggested, the 
hospitals for mental diseases in this State can properly be developed to a capacity 
of two thousand beds, provisions for bringing this hospital up to that size would 
seem to be clearly indicated if the needs of the City of Boston are to be considered. 
Needs of the Hospital for the Coming Year 
The following items relating to construction deemed necessary for the coming 
year have been submitted to the Department of Mental Diseases: 



1. Administration Building and Staff Quarters (requested in 1919, 

1920, 1921, 1922, 1923, 1924, and 1925) $180,000 

2. Extension to Sewer, Water and Steam Lines (requested in 1920, 

1921, 1922, 1923, 1924, and 1925) 13,000 

3. Addition to Garage (requested in 1920, 1921, 1922, 1923, 1924, and 

1925) 4,200 

4. Purchase of Additional Land (requested in 1918, 1919, 1920, 1921, 

1922, 1923, 1924, and 1925 50,000 

5. Concrete Platform for Coal Storage (requested in 1920, 1921, 1922, 

1923, 1924, and 1925) ' 6,000 

'9 Cottage for Farm Employees (requested in 1921, 1922, 1923, 1924, 

and 1925) 30,000 

Total $283,200 



P.D. 84 29 

1. Administration Building and Staff Quarters. — The offices of the institution 
are now located in an old building purchased by the City of Boston about fifty 
years ago for use as an almshouse. This is a two and one-half story building con- 
structed of wood throughout, contains numerous exposed electric wires, and has 
several wooden stairways running from the basement to the attic. This building 
is located within 50 yards of a large wooden barn containing hay, and is surrounded 
by other non-fireproof structures, the nearest being the chapel and a building 
occupied by patients. Its presence in this location is a serious menace, and in case 
of fire would threaten the loss of the entire East Group. The building now houses 
about thirt\'-six employees, twenty-five of whom are li\ing in the attic. The offices 
of the hospital should be in a central location. It is very inconvenient for relatives 
and friends of the patients to come from Walk Hill Street to the present adminia- 
tration building. The hospital has now reached a stage of development where an 
administration building is urgently needed. We do not propose to demolish the old 
wooden building now used for office purposes, but suggest remo\ing it to other 
locations where it can be remodelled and used for housing employees, etc. In 
erecting an administration building we propose to provide additional accommoda- 
tions for the staff on the second floor. Attention should be called to the fact that 
no new construction has ever been pro\ided at the institution as yet for the ex- 
clusive use of the medical officers of the hospital. 

2. Extension to Seicer, Water and Steam Lines. — When a new administration 
building is erected, an extension to the sewer, water and steam lines of the institu- 
tion will be necessary. Pro\ision should be made for this at as early a moment as 
possible. When completed, this extension will also pro\ide for several other 
buildings. 

3. Addition to Garage. — No garage has ever been built for the hospital. We 
are using the old West Group boiler house, remodelled for this purpose, at the 
present time. It is, however, not large enough, and additional space is badly 
needed. 

4. Purchase of Additional Land. — Attention should be called again to the 
desirability of acquiring the 150,000 square feet of land belonging to the Forest 
Hills Cemetery and located south of Canterbury Street, adjoining the West Group. 
This is the only part of the site bounded by Canterburj^ Street on the north. 
Harvard Street on the south, Morton Street on the east, and Walk Hill Street on 
the west, that has not as yet been acquired by the State. The buildings on the 
land could be used to very good advantage and would facilitate the removal of 
the barns and other objectionable structures adjoining the administration building 
in the East Group. The desirability of acquiring this land was referred to by the 
joint special legislative committee on public institutions in their report of March, 
1920, as shown in Senate Document No. 450. 

5. Concrete Platform for Coal Storage. — The recommendations of the consulting 
engineers representing the Department of Mental Diseases show that we should 
be able to take care of at least 6,000 tons of coal at one time. At the present this 
is done by spreading the coal over a large space near the power house. This land 
is low and is frequently overflowed by water from the Canterbury Branch of 
Stony Brook. A considerable loss would be prevented by storing this coal on a 
cement platform (20,000 square feet). 

6. Cottage for Farm Employees. — Attention has been called to the necessity of 
further provision for the housing of farm employees. The building now used for 
this purpose in the West Group is one which has been in constant use since 1904. 
It has been remodelled throughout on several occasions and cannot be repaired 
further to good advantage. The building inspectors of the District Police have 
refused to certify it for occupancy, and it should be replaced at the earliest possible 
moment. Respectfully submitted, 

Nevember 30, 1926. JAMES V. MAY, Superiniendent. 



30 



VALUATION 



P D. 84 



November 30, 1926. 
Real Estate 

Land, 233 acres $609,508.00 

Buildin-s 2,645,968.09 



$3,255,476.09 



Personal Property 

Travel, Transportation and Office Expenses $780 . 00 

Food 30,899.56 

Clothing and Materials 28,961 . 12 

Furnishings and Household Supplies 257,345.79 

Medical and General Care 3,288.02 

Heat, Light and Po^er 7,179.38 

Farm 7,841.97 

Garage, Stables and Grounds 6,941.03 

Repairs 10,785.28 



$354,022.15 



Summary 

Real Estate $3,255,476.09 

Personal Property 354,022.15 



$3,609,498.24 

TREASURER'S REPORT 

To the Devarimeni of Mental Diseases. 

I respectfully submit the following report of the finances of this institution for 
the fiscal year ending November 30, 1926. 

Cash Accoxjtnt 
Receipts 

Income 
Board of Patients: 

Reimbursing $115,685.78 

$115,685.78 

Personal Services: 

Reimbursement from Board of Retirement 226 . 04 

Sales: 

Travel, transportation and ofiBce expenses 142 . 07 

Food 414.46 

Clothing and materials 42 . 01 

Furnishings and household supplies 53.15 

Medical and general care 1 . 00 

Heat, Light and Power 7 . 56 

Farm: 

„ Hay 100.00 

Repairs, ordinary 48.76 

Miscellaneous: 

Interest on bank balances 606 80 

Rent 111.00 

$717.80 

Total Income $117,438.63 

, , Maintenance 

Brought forward and paid from small items $8 . 85 

Balance from previous year, brought forward $11,562 . 56 

Appropriations, current year $784,235.00 

„ Total $795,806.41 

Expenses (as analyzed below) 758,517.27 

Balance reverting to Treasury of Commonwealth 37,289 . 14 



P.D. 84 31 

Analysis of Expenses 

Persona! Se-viw* $368,453 . 30 

Religioii? Instruction 2,079.98 

Travel, Transportation and Office Expenses 6,837 . 44 

Food 190,025.28 

Clothing and Materials 29,965 . 29 

Furnishings and household supplies 44,705 . 60 

Medical and General Care 27,120 .13 

Heat, Light and Power 53,646 . 88 

Farm 5,752.17 

Garage, Stable and Grounds 6,942.24 

Repairs, Ordinar>- 15.049 . 13 

Repairs and Renewals 7,939 . 83 



Total expenses for Maintenance $758,517.27 

Specl\l Appropriations 

Balance December 1, 1925 $19,461 . 78 



Total $19,461.78 

Fxpended during the year see statement below) . ^ $3,102 . 74 

Reverting to Treasurj- of Commonwealth 8.76 

3,111.50 



Balance November 30, 1926, carried to next year $16,350 .28 



1 Act , Expended Total Balance 

Object or Whole ; During : Expended j at End 

Resolve Amount \ Fiscal Year To Date Of Year 



Dining Room, Ejist Group 211-1919 S152,000.00 3150,579.32 

I 629-192C, I 

-Additional Fire Protection ! 510-1924 4,400.00 • 32.34 | 4,391.24 

Fire Protection 1925 347-1925 13,000.00 3,070.40 5,070.40 



$1,420.68 

8.76* 
14,929.60 



->174.400.00 



S3.102.74 ; S158.040.96 



$16,359.04 



Balance reverring to Trea3ur>- of the Commonwealth during year tmark item with *) . 
Balance carried to nest year 



8 76^ 
16,350.28 

Total as above $16,359.04 

Per Capita 

During the year the average number of inmates has been 2,132 . 40. 
Total cost for maintenance, $758,517.27. 

Equal to a weekly per capita cost of S6.8405, (52 weeks to year) 

Receipt from sales, SSC9 01. 

Equal to a weekly per capita of S . 00729. 

All other institution receipts. $116,629.62. 

Equal to a weekly per capita of $1.0518. 

Net weakly per capita S5!7814. 



Respectfully submirred, 

ADELINE J. LEARY 



Treasurer. 



32 



P.D. 84 



STATISTICAL TABLES 



As Adopted by the American Psychiatric Association- 
Prescribed by the Massachusetts Department of Mental Diseases. 

Table 1. General Information. 



Data correct at end of institution year, November 30, 1926. 

1 Date of opening as an institution for the insane, December 11, 1839. 

2. Type of institution: State, (since December 1, 1908.) 

3. Hospital plant 

Value of hospital property: 

Real estate including buildings $3,255,476 . 09 

Personal property 354,022. 15 

Total $3,609,498.24 

Total acreage of hospital property owned, 233.074 acres. 

(Includes grounds, farm and garden and sites occupied by buildings.) 
Total acreage under cultivation during previous year, 138 acres 

(Includes land owned and rented) 

4. Officers and Employees: Year ending September 30, 1926. 

Actually in Service at End of Year Vacancies at End of Year 
Males Females Total Males Females Total 

Suoerintendents 1 

Assistant physicians 8 

Medical internes 

Clinical assistants 

Total physicians 9 

Stewards 

Resident dentists 

Graduate nurses 

Other nurses and attendants Ill 

Teachers of occupational therapy 1 

Social workers 

All other officers and employees 81 

Total officers and employees 204 

5. Census of Patient Population at end of year September 30, 1926. 

Actually in Institution 

Males Females Total 



1 





1 











8 


23^ 


10 H 


3 


1^ 


4H 






































9 




'uli 


3 


IH 


4H 


. 1 





1 











1 





1 














12 


12 1 








111 


124 


235 ) 


6 


11 


17 


1 


5 


6 





5 


5 





3 


3 











81 


74 


155 


21/2 





2H 


204 


220 H 


424 H 


11 H 


17 H 


29 



Absent from Institution 
but still on books 
Males Females Total 
220 



877 


1200 


2077 


102 


118 


21 


24 


45 


3 


3 


898 


1224 


2122 


105 


121 



226 
Total 



Males Females 

Patients employed in industrial classes or in general hospital work 

on date of report, September 30, 1926 528 520 

Average daily number of all patients actually in institution during 

year 907.67 1216.85 2124.52 



1048 



Table 2. Financial Statement. 
See treasurer's report for data requested under this table. 



P.D. 84 



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84 P.D. 84 



Table 4. Nativity of First Admissions and of Parents of First Admissions for the 
Year Ending Sevtemh?r 30, 1926. 



Nativity 


: 

M. 


^ATIEWTS 
F. 


T. 


Parents of Male 
Patients 

Both 

Fathers Mothers Parents 


Parents of Female 
Patients 

Both 

Fathers Mothers Parents 


United States . . • 


84 


109 


19.3 


32 


27 


22 


48 


49 


38 






6 


11 


6 


5 


5 


g 


g 


g 




1 





1 


1 


\ 









Q 




21 


23 


44 


17 


23 


17 


17 


23 


13 


£n^l£Lnd • • • 


2 


13 


15 


5 


4 


2 


13 




9 













1 


1 


2^ 


Q 


Q 


Q 


Germany 


4 


1 




5 


6 


5 


4 


2 


1 




2 





2 


2 


2 


2 











Hollantl 




















1 





1 


Ireland 


27 


43 


70 


55 


51 


48 


76 


78 


69 


Italy 


10 


4 


14 


10 


10 


10 


4 


4 


4 


Jugo-Slavia 

Poland 





1 


1 











1 


1 


1 


3 


4 




1 


1 


1 


2 


2 




Portugal 




















1 












12 


17 


G 


6 


6 


17 


18 


17 




2 


4 


G 


3 


3 


2 


5 


3 


3 


South America . . . . 




















1 








Sweden 


3 


1 


4 


3 


4 


3 


2 


2 


2 


Switzerland 


1 





1 


1 


1 


1 











Turkey in Asia .... 


1 





1 


1 


1 


1 











Wales 





1 


1 











1 


1 


1 


Unascertained 





2 


2 


22 


25 


20 


24 


24 


23 


Total 


171 


225 


■ 390 


171 


171 


147 


225 


225 


190 



♦Includes Newfoundland. 



P.D.84 



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Age Groups 


Under 15 years 

15—19 years 

20—24 years 

25—29 years 

30—34 years 

35—39 years 

46 — 49 years 

50—54 years 

60 — 64 years 

70 years and over . . . 





36 ^ 
Table 5. Citizenship of First Admissions for the Year Ending September 30, 1926. 



Citizens by birth 

Citizens by natunlization 

Aliens • • • • 

Citizenship unascertained 

Total 



15 
171 



109 
32 
47 
37 



193 

83 



396 



Table 6. Psychoses of First Admissions for the Year Eyiding September 30, 1926. 



PSYCHOSI 



M. 



T. 



10. 



13. 



Traumatic psychoses 

Senile psychoses • ■ • 

Psychoses with cerebral arteriosclerosis 

General paralN-sis • • 

Psvchoses with cerebral s\T)hilis 

Psychoses with Huntington's chorea 

Psvchoses with brain tumor • - • 

Psychoses with other brain or nervoiis diseases, total . . . 

Cerebral embolism 

Paral\-si5 agitans 

Tab€ss dorsalis 

Other diseases 

Alcoholic psychoses, total 

Delirium tremens. 

Korsakow's psychosis 

Acute hallucinosis 

Other tN-pes, acute or chronic ■ 

Psvchoses' due to drugs and other exogenous toxins, total 

Opium (and derivatives), cocaine, bromides, chloral, 
etc., alone or combined 

Other exogenous toxins 

Psychoses with i>ellagra 

Psychoses with other somiatic diseases, total 

tardio-renal diseases 

Diseases of the ductless glands 

Other diseases or conditions 

Manic-depressive psychoses, total 

Manic tj-pe 

Depressive type 

Other types 

Involution melancholia 

E>ementia praecox t;schizophrenia) 

Paranoia and paranoid conditions 

Epileptic psj choses 

Psj choneuroses and neuroses, total 

H>-5terical type 

Psj chasthenic type (anxiety and obsessive forms) . . . 

Neurasthenic type 

Psychoses with psj'chopathic personality 

Psychoses with mental deficiency 

Undiagnosed p5%-cho5es 

Without psjxhosis, total 

Psj chopathic personality without psychosis 

Mental deficiency without psychosis 

Others 



M. 



20 



13 



Total . 



22= 



396 



I 



P.D. 84 37 

Table 7. Race of First Admissions Classified with Reference to Principal Psychoses, 
for the Year Ending September 30, 1926. 



Race 



African (black) 
Dutch and 

Flemish 

English 

German 

Greek 

Hebrew 

Irish 

Italian* 

Lithuanian . . . 

Mag>-ar 

Scandinaviant. 

Scotch 

Slavonic + 

S^■Tian 

Welsh 

West Indian 

Mixed 

Race unasc't'd 



Total 



M. I F. T, 



14 

1 
35 
6 
1 
17 
133 
18 
5 
8 
5 
10 
10 
1 
1 
1 
103 
27 



Total 171 225 396 ' 



Traumatic 



Senfle 



M. F. T 



With 
cerebral 
arterio- 
sclerosis 



M. F. T. 



13 26 



14 



12 



39 



M. F. -T 



108 



General 
paralysis 



With 
cerebral 

syphilis 



M. F. T. 



25 8 



33 



M. F. T. 



♦Includes "North" and '"South"'. tNorwegians, Danes and Swedes. Except Cuban. 

JIncludes Bohemain, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 



Table 7. Race of First Admissions Classified mith Reference to Principal 
Psychoses, for the Year Ending September 30, 1926. — Continued. 



Race 


With 
Hunting- 
ton's 
chorea 


1 With 
brain 
tumor 


1 

! With other 
brain or 

1 nervous 
diseases 


Alcoholic 


Due to 
drugs and 

other 
exogenous 

toxins 


With 
pellagra 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


African (black") 




















1 





1 














Dutch and Flemish 

English 











1 


1 


1 


1 


2 





1 


1 














German 




















1 





1 














Greek 




















































1 





1 


































1 





1 


11 


5 


16 





2 


2 








Italian* 




















1 





1 














Lithuanian 


























































1 





1 














Scandinaviant 




















1 





1 














Scotch 






































Slavonic J 












































































Welsh 























1 


1 














West Indian * 





1 


1 
































Mixed 












4 





4 


4 





4 














Race imaseertained 














1 


1 


2 





1 


1 














Total 














1 


1 


8 


2 


10 


20 


8 


28 1 





2 


2 












''Includes "North" and "South". 
tNorwegians, Danes and Swedes. 

Jlncludes Bohemian, Bosnian, Croatian, Delmatian, Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Serbian, Slovak, Slovenian- 
"Except Cuban. 



38 P.D. 84 

Table 7. Race of First Admissions Classified with Reference to Principal 



PsycJioses, for the Year Ending September 30, 1926 — Continued. 





























Paranoia 










With other 








Involution 










and 












somatic 


Manic- 


melan- 


Dementia 


paranoid 


Epileptic 




diseases 


depressive 


cholia 


praecox 


conditions 


psychoses 


Race 








































TV, I 


— s — 


1 , 


iVl . 


r . 


J. . 


■ 

M. 


F 


1 . 


ivr 


F 


i . 


iVl. 




T. 


M. 


F. 


T. 


African (black) . . 







1 


1 





2 


2 





1 


1 




















Dutch, Flemish. . 


- 






1 





1 































1 


1 





8 


8 







3 


1 


2 







2 


2 










1 





1 


1 





1 













1 










_ 


_ 






































- 










1^ 












X 


3 


4 
















2 


o 


4 


5 


11 


16 





2 


2 





10 


10 


2 


6 


8 


1 





1 













2 


o 








4 





4 


1 


1 


? 








Lithuanian 











2 













1 


1 





1 





















1 


1 














n 




2 








Scandinavian! ■ . • 























1 


1 





1 


1 
















1 


1 


2 

















2 


2 
















1 


2 


o 
































































Welsh 






































West Indian ° . . . 


_ 


: 







1 
































3 


5 


3 


6 


9 


1 


1 


2 


3 


1 


4 


3 


2 


5 








Race un'certaiaed 





3 


3 





2 


2 


























To'al 


5 


10 


15 


13 


42 


55 


1 




8 


10 


18 


28 


6 


17 


23 


T 





1 



♦include "North" and "South". 
tNorwegians, Danes and Swedes. 

jlncludes Bohemian, Bosnian, Croatian, Delmatian, Herzegovian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 
"Except Cuban. 



Table 7. Race of Fist Admissions Classified with Reference to Principal 
Psychoses, for the Year Ending Sevtember 30, 1926 — Concluded. 





Psycho- 


With 
























neuroses 


psycho- 




With 




Un- 




Without 


Race 




and 




pathic 


mental 


diagnosed 


D.svchos 


is 




neiiroses 


personality 


deficiency 


psychoses 










M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


African (black) 























1 


1 








Dutch and Flemish 
































English 


1 
















1 


1 





1 


1 








German 

















































































3 


3 


1 





1 

























3 


3 


3 


4 







2 


2 
















1 





1 


2 




3 































































2 




1 





1 


Scandinavian! 
































Scotch 























1 


1 








Slavonic J 




















3 


1 


4 








Syrian 
































Welsh 
































West Indian ° 
































Mixed 






2 








1 





1 


2 


3 


5 








Race unascertained 

















1 


1 


1 


1 


2 


1 





1 


Total 


1 


2 


3 











2 


8 


10 


12 


15 


2T 


2 


2 


4 



P.D. 84 



39 



Table 8. Age of First Admissions Classified with Reference to Principal 



Psychoses, for the Year Ending Sevtembsr 30, 1926. 



Psychoses 


Total 


Under 
15 years 


15-19 
years 


20-24 
years 


25-29 
j'ears 




M. 


F. 


T. 


M 

— 


F. 


T. 




M. 




F. 




T. 




M. 


F. 


T. 


M. 


F. 


T. 











39 

108 
33 
1 

1 































13 

51 
25 
J 





26 

57 
8 




















_ 






3. With cerebral arterioscle- 














i - 










- 






















1 





i 


5. With cerebral sypliilis .... 

6. With Huntington's chorea 




1 




















8. With other brain or nerv- 


8 


2 


10 
28 








1 





1 
















20 


8 


: 




_ 




_ 


_ 


_ 


2 





2 


10. Due to drugs and other ex- 





2 


2 


























11. With pellagra 



































12. W^ith other somatic diseases 

13. Manic-depressive 


5 
13 


10 
42 


15 
55 


- 




- 


1 2 


2 


4 


1 


3 


4 


1 


5 


6 

8 


14. Involution melancholia . . . 

15. Dementia praecox 


10 
6 


18 


c 
o 

23 











2 


2 


3 


6 


9 


6 


2 


16. Paranoia or paranoid con- 


17 


23 






















17. Epileptic psychoses 


1 





1 


























18. Psychoneuroses and neu- 


1 


2 


3 


























19. With psychopathic per- 
sonality 



































20. With mental deficiency. . . 

21. Undiagnosed psychoses. . . 

22. Without psychosis 


2 
12 
2 


r. 

15 
2 


10 
27 
4 








1 
1 




b 


1 

i 


1 





1 



2 


4 



4 
2 


Total 


171 


225 


396 





n 


3 


5 


4 


9 


5 


9 


14 


19 


11 





Table 8. Age of First Admissions Classified with Reference to Principal 
Psychoses, for the Year Ending September 30, 1926 — Continued. 





30-34 




35-39 




40-44 




45-49 




50-54 


Psychoses 


years 






years 




year 






years 




years 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


1. Traumatic 
































































3. With cerebral arterio- 
































sclerosis 

























2 


1 


6 


7 


4. General paralysis 


1 





1 


2 





2 







3 


4 


o 


7 




3 


10 


5. With cerebral syphilis . 








1 





1 




















6. With Hunt'ton's chorea 
































7. With brain tumor 











1 


1 




















8. With other brain or 
































nervous diseases .... 


1 





1 











1 


1 








2 





2 


P. Alcoholic 


2 





2 


2 


1 


3 


3 


2 


5 


1 


3 


4 




1 


3 


10. Due to drugs and other 
































exogenous toxins .... 











1 


1 











1 


1 








11. With pellagra 
































12. With other somatic 


































1 





1 





2 


2 





3 


3 





2 


2 





1 


1 


13. Manic-depressive 


2 


9 


11 


1 


4 


5 


1 


8 


9 






7 





i 


1 


14. Involution melancholia 






















1 


1 





3 


3 


15. Dementia praecox .... 


1 


1 


2 





3 


o 














1 


1 





2 


2 


16. Paranoia or paranoid 
































conditions 


1 


3 


4 


1 


1 


2 











5 


5 


2 


4 


6 


17. Epileptic psychoses . . . 


























1 





1 


18. Psychoneuroses and 


































1 


1 


2 


























19. With psychopathic per- 
































































sonality 

20. With mental deficiency 





1 


1 


1 


1 


2 





1 


1 





1 


1 








21. Undiagnosed psychoses 


4 


4 


8 




1 


2 


1 


2 


3 


1 


1 


2 





3 


3 


22. Without psychosis .... 





1 


1 





1 


1 


1 





1 














Total 


14 


20 


34 


9 


16 


25 


9 


17 


26 


10 


23 


33 


15 


24 


39 



40 P.O. 84 

Table 8. Age of First Admissions Classified with Reference to Principal 



Psuchoses, for the Year Ending September 30, 1926 — Concluded. 



Psychoses 


55-59 
years 


60-64 
years 


65-69 
years 


70 years 
and over 


Unascer- 
tained 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 




































1 


1 


2 


1 





1 


1 


5 


6 


10 


20 


30 








3. With cerebral arterio- 


6 


4 


10 


9 


14 


23 


10 


6 


16 


23 


27 


50 








4. General paralysis 


2 


2 


4 


3 





3 


2 





2 








5. With cerebral syphilid 

6. With Huntington £ 






























































8. With other brain or ner- 


3 






3 

o 


1 

3 





1 

4 



2 


1 



1 

2 
















3 


1 














10. Due to drugs and other 

exogenous toxins 

11. With pellagra 




















12. With other somatic 


1 


1 


2 


2 





2 


1 


1 


2 














13. Manic-depressive. ..... 


2 


1 


o 





3 


3 


1 


1 


2 














14. Involution melancholia . 

15. Dementia praecox 

16. Paranoia or paranoid 

conditions 






2 
2 


2 
2 


1 


2 



1 

1 


1 
1 

3 






1 
1 


1 
1 














17. Epileptic psychoses. . . 

18, Psychoneuroses anci 

















1 


1 














19. With psychopathic per- 
sonality 






























20. With mental deficiency . 

21. Undiagnosed psychoses . 

22. Without psychosis 





1 


1 


2 


1 


3 





1 


1 





1 


1 








Total 


18 


14 


32 1 


24 


21 


45 


17 


18 


35 


33 


48 


81 






















P.D. 84 



41 



Unascer- 
tained 






1 1 iHN I 


1 rH,-( 1 ,-( 1 




!-!■>* 1 


to 
CO 




1 ■>*o»-i 1 


1 1 OrH 1 






r-IW 1 


N 




,«»» , 


1 1 THrH 1 


1 OO 1 O 1 


o 


OrH 1 










1 1 .H 1 1 


1 1 CO 1 <-t 1 






00 




CoUeg 




I r1 1 r-t 1 


1 1 11 1 1 


I 1 1 tH 1 1 




1 1 O 


<o 


hool. 




1 O 1 O 1 


1 1 O 1 1 


1 1 rH 1 O 1 1 




1 1^ 


(M 


in scl 






1 MNeo 1 


, l^^l 


1 N»Or-lr-( 1 1 


1 


Ni-I 


CO 
N 


grade 


High 
Schoo 




1 tHOO I 


1 1 1-IO 1 


1 O-^TiHTlfiH 1 


1 


1 C40 




urth 




1 iHN« 1 


1 0.-1 1 


1 NrHOeOO 1 


1 1 


1 0»H 




ete £c 






1 O0«Ot-lH 
r-llO r-t 




ooot-oo«o 1 
,-ieo i-HiH 


N 1 




o 

eo 

(M 


compl 


Comm( 
Schoo 








t- 00 T-l rH lH 
N 1-1 




1 lOlfl 


eo 


not ( 






ot-eoo 


eOOr-tt-U5 1 


1 


T-lOO 


t- 
o 


ho did 



If 



I I O I I MkO I iHCOO 



©1-1 I 0»H, 



2 H 



2 



o g § rt^^ 

M « M 2 

c o -ii o a (3 M 



^|gi||5ill 



42 P.D. 84 

Table 10. Environment of First Admissions Classified with Reference 



to Principal Psychoses, for the Year Ending September SO, 1926. 



Psychoses 


Total 


Urban 


Rural 


Unascer- 
tained 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F 


1 


AT 
iVl. 


r . 


JL . 







Q 


Q 


Q 





Q 
















13 


26 


39 


13 




OV 
















51 


57 


108 


51 


57 


108 
















25 


8 

Q 


33 


25 


8 


33 
















]^ 




]^ 


Q 
















6. With Huntington's chorea 


Q 










Q 


Q 



















1 









1 














8. With other brain or nervous diseases 


g 


2 


10 


g 


2 


10 
















20 


g 


28 


20 


g 


98 














10. Due to drugs and other exogenous 























2 


2 





2 


2 
















































5 


10 


15 


5 


10 


15 
















13 


42 


55 


13 


42 


55 
















1 


7 


8 


1 


7 


g 
















10 


18 


28 


10 


18 


28 














16. Paranoia or paranoid conditions. . . . 


6 


17 


23 


6 


17 


23 
















1 





1 


1 





1 














18. Psychoneuroses and neuroses 


1 


2 


3 


1 


2 


3 














19. With psychopathic personality 
































20. With mental deficiency 


2 


8 


10 


2 


8 


10 














21. Undiagnosed psychoses 


12 


15 


27 


12 


15 


27 
















2 


2 


4 


2 


2 


4 
















171 


225 


396 


171 


225 


396 















Table 11. Economic Condition of First Admissions Classified with 
Reference to Principal Psychoses, for the Year Ending September 30, 1926. 



Psychoses 


Total 


Dependent 


Marginal 


Com- 
fortable 


Unascer- 
tained 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


1. Traumatic 





































13 


26 


39 


8 


16 


24 


4 


8 


12 








1 


2 


3 


3. With cerebral arterio- 


































51 


57 


108 


17 


33 


50 


32 


15 


47 


2 


1 


3 





8 


8 




25 


8 


33 


6 


3 


9 


19 


4 


23 











1 


1 


5. With cerebral syphilis . . 


1 





1 








1 





1 














6. With Huntington's 
































chorea 



































7. With brain tumor 





1 


1 











1 


1 














8. With other brain or ner- 


































8 


2 


10 


5 


2 


7 


3 





3 














9. Alcoholic 


20 


8 


28 


4 


1 


5 


15 


7 


22 








1 





1 


10. Due to drugs and other 
































exogenous toxins .... 





2 


2 











2 


2 














11. With pellagra 



































12. With other somatic 






























diseases 


5 


10 


15 


1 


4 


5 


3 


5 


8 


1 





1 





1 


1 




13 


42 


55 





2 


2 


12 


37 


49 


1 


1 


2 





2 


2 


14. Involution melancholia . 


1 


7 


8 








1 


7 


8 
















10 


18 


28 


2 


2 


4 


7 


15 


22 








1 


1 


2 


16. Paranoia or paranoid 
































conditions 


6 


17 


23 





2 


2 


5 


13 


18 


1 


2 


3 








17. Epileptic psychoses . . . 


1 





1 








1 





1 














18. Psychoneuroses and 


































1 


2 


3 








1 


1 


2 





1 


1 








19. With psychopathic per- 



































































20. With mental deficiency . 


2 


8 


10 


1 


2 


3 


1 


6 


7 














21. Undiagnosed psychoses. 


12 


15 


27 


1 


3 


4 


10 


7 


17 





2 


2 


1 


3 


4 


22. Without psychosis 


2 


2 


4 








2 


2 


4 














Total 


171 


225 


396 


45 


70 


115 


117 


130 


247 


5 


7 


12 


4 


18 


22 



P.D. 84 43 

Table 12. Use of Alcohol by First Admissions Classified with Reference to 
Principal Psychoses, for the Year Ending September 30, 1926. 



Total 



II M. 



19. 



Traumatic 

Senile 

With cerebral arteri- 
osclerosis 

General paralysis. . . 

With cerebral 
syphilL" 

With Huntington's 
chorea 

With brain tumor . 

With other brain or 
nervous dieseases 

Alcoholic 

Due to drugs and 
other exogenous 
toxins 

With pellagra 

With other somatic 
diseases 

Manic-depressive. . . 

Involution melan- 
cholia 

Dementia praecox . . 

Paranoia or paranoid 
conditions 

Epileptic psychoses . 

Psychoneuroses and 
neuroses 

With psychopathic 
personality 

With mental de- 
ficiency 

Undiagnosed psy- 
choses 

Without psychosis . . 

Total 



108 



27 
4 

396 



Abstinent 



M. 



40 



13 



5 

8 
3 

138 



Temperate 



M. 



47 



F. 



57 



104 



Intem- 
perate 



M. 



24 



87 



Unascer- 
tained 



M. 



21 



T. 



67 



44 



P.D. 84 



'S, CO 



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o ^ 

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1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 




Jnasc( 
tainei 




1 1 1-I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


f-t 






1 1 1-1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 




-a 










1 


III! 


t- 


ivorc< 
















Q 








1 O 1 1 r-l 


1 


1 1 I 




•s 


Eh* 


1 1 1 rt 1 






1 


1 1 iH 




parat 


pel 






1 1 1 r^rt 








<i> 
w 




1 1 1 M 1 




1 I 1 OO 




1 1 o 




-s 




1 rHUMO 1 

NT)" 


1 rH^J 1 


■<1< <0 r-l rH eO r 


■tl-l 


1 C4 t 


eo 
o 


idow( 




1 ej 05 1 




«<Ot-ioeooiH 




(O 






1 t- eo w 1 


1 O i-H 1 


THOOr-lOr- 


HO 


1 1-1 1 


N 






1 lO OO 1 
COM 




00OJt-i-HU3 






M 

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Marrie 




1 COOtJ" 1 


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o 


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00 




1 eg CO CO 1 

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e050rHOl0 




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eooj 1 u3eo 


rH 






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00 






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O^t-00OOrHN00CJOOC<It-00t-ONO00li5ea 




+j c M ^ rLsS 



P.D. 84 45 

Table 14. Psychoses of Recdmissions for the Year Ending September 30, 1926. 



Psychoses 



Males 



Females 



Total 




Traumatic psychoses 

Senile psychoses 

Psychoses with cerebral arteriosclerosis 

General parah-sis 

Psychoses with cerebral s>'philis 

Psychoses with Huntington's chorea 

Psychoses with brain rumor 

Psychoses with other brain or nervous diseases . . . . 

Alcoholic psychoses 

Psychoses due to drugs and other exogenous toxins 

Psychoses with pellagra 

Psychoses with other somatic diseases 

Manic-depressive psychoses 

Involution melancholia 

Dementia praecox 

Paranoia and paranoid conditions 

EpUeptic psychoses 

Psychoneuroses and nexiroses 

Psychoses with psychopathic personality 

Psychoses with mental deficiency 

Undiagnosed psychoses 

Without psychosis 

Total 



Table 15. Discharges of Patients Classified with Reference to Principal Psychoses 
and Condition on Discharge for the Year Ending September 30, 1926. 









Total 




Recovered 


Improved 


Unimproved 




Psychoses 






























M 


. F. 


T. 


M. 


F. 


T. 


M 


F. 


T. 


M. 


F. 


T. 


1. 




3 





3 








2 





2 


1 





1 


2 




1 


12 


13 











5 


5 


1 


7 


8 


3. 


With cerebral arteriosclerosis. . . 


4 


8 


12 





1 


1 


1 


2 


3 


3 


5 


8 


4. 




6 


2 


8 








5 


2 


7 


1 





1 


5. 


With cerebral sj-philis 


2 





2 








2 





2 








6. 































7. 


With Himtington's chorea 





























8. 


With other bmin or nervoTis 






























1 


1 


2 








1 


1 


2 








9. 




9 


11 


20 


3 


3 


6 


6 


6 


12 





2 


2 


10. 


Due to drugs and other ex- 




























genous toxins 





























11. 































12. 


With other somatic diseases .... 


1 


1 


2 


1 





1 





1 


1 








13. 


Manic-depressive 


26 


53 


79 


21 


17 


38 


4 


31 


35 


1 


5 


6 


14. 


Involution melancholia 


2 


4 


6 


1 





1 


1 


2 


3 





2 


2 


15. 




16 


22 


38 








15 


17 


32 


1 


5 


6 


16. 


Paranoia or paranoid conditions 


2 


10 


12 





1 


1 


2 


4 


6 





5 


5 


17. 


Epileptic psychoses 


1 





1 








1 





1 








18. 


Psychoneuroses and neuroses . . . 


2 


2 


4 








2 


2 


4 








19. 


With psychopathic personality. . 


2 


2 


4 


1 





1 


1 


2 


3 








20. 




4 


13 


17 


1 


4 


5 


3 


8 


11 





1 


1 


21. 







3 


3 











3 


3 








22. 


Without psychosis 


4 


3 


7 






















Total 


86 


147 


233 


28 


26 


54 


46 


86 


132 


8 


32 


40 



P.D 



Involution 
melancholia 


1 


1 1 Nt-i 1 IIINi»-<l INI 1 11 1 'l 


00 






la 








1 > 

|l 




rHilll r-l|| t-l|rH| 1 rtOa 1 II 1 II 


a 




r-i|||l Oil OlOl 1 CQN 1 II 1 II 


iO 








Alcoholic 




I 1 Ca 1 i III rH 1 1 1 1 lOr-t 1 1 1 1H 1 1 


o 




1 1 O 1 1 111 rH 1 1 1 1 r-lO I 1 1 O 1 I 


N 


1^1 111 Olll 1 ■cl'rH 1 1 1 iH 1 1 

^ 1 




General 
paralysis 


Eh' 


1 1 1 1 1 O 1 CC III 1 00 1 1 II 1 1 


00 

n 




ll<-l|| ICOI i-llll lOl 1 II 1 Ol 


o 




IIOII IMI (Nil! INI I 11 1 r-ll 


N 


With cerebral 
arterio- 
sclerosis 


E-; 


1 1 1 (NrH 'S" 1 1 t-l .-ii-i 1 1-iCD rf 1 1 1 II 


t- 

o 




1 1 1 i-ii-i (Mil 00 1 cii-H 1 no Nil 1 II 


t- 




1 1 1 rHO Nil Oi 1 NO 1 005O Nil 1 II 

tH t-H 


o 
\o 


vSenile 


Eh' 


1 THe^r-i 1 i-H 1 1 o 1 00 1 Nt- 1 eo 1 >-i 1 i i 

N N 


o 




1 ooo 1 oil io 1 ^ 1 on 1 o 1 I-H 1 II 


n 




1 i-INrH 1 i-l 1 1 lO 1 Ti< 1 C<lTj< 1 CO 1 O 1 II 


N 


Total 


Eh* 


Ni-HC<13Ci-i 05»ai-i 00i-H-<?rH N Ol"^ 0> rH rH N r-i T-l 
N 1-1 00 CO OJrH 


n 

rH 

CO 




NO(35CCrH -^NrH CO rH lO rH O^^ rH rH rH OO 
O rH lO 


N 
t- 




OrHCONO iOnO OOCJO NifflOO U5 OO rH rH rH 
rH ^ r-l r}< 





S E. 



o 



11 



5 -g' 



t- S 03 

>> o 
£5 



CD S 
cts u t-, ^ 
' o o « 



>.c.S 
o c"S 



cc o 50 



el 

£•8 



« o tj 

c c S 



C PL 



at) 



P.D. 84 



47 



1 i 

? S. 




1 1 eo.-i 1 


1 »H 


O 1 N 1 


1 «Oi-l 1 1-1 1 




t- 

<N 




1 1 t-H^ 1 


' ^ 


«£> 1 1-1 1 


1 no 1 1-1 1 


1 1 1 


U3 




1 1 N 1 1 


1-1 1 o 


TJ- 1 1 


1 nr-i 1 o 1 


1 1 1 


(M 
1-1 


ll 




1 1 1 1 1 


1 1 1 


^1^1 


III 1 1 , 


^ 1 ^ 




il 








1-1 1 O 1 




i-< 1 O 








1 1 1 1 1 




O 1 1-1 1 




O 1^ 


. 






1 1 1 1 1 III 1 1 1 1 III 1 II 1 II 


O 


With 
chops 
'sonal 






O 


^® 




1 1 1 1 1 III 1 1 1 1 III 1 II 1 II 


o 


of! 




1 1 1 ! 1 1 1 1 1 1 1 III 1 II 1 II 




•Sis 

m S C 






iH 


^ CO 

c 
es 




1 1 1 1 1 O I 1 1 1 1 1 III 1 II 1 II 


o 


•2S 




1 1 1 1-1 1 III 1 1 1 1 III 1 II 1 II 




c.g 
•— u 




1 1 1 1 <-i 1 III 1 1 1 1 III 1 II II 


f-l 


^ a 




1 1 1 O 1 III 1 1 1 1 III 1 II 1 II 


o 






1-1 1 earl 1 


1 1 i 


1 1 1 






00 


anoia 
iranoi 
iditio 






1 1 1 


<N 1 1 1 












O 1 1 




O 1 ! 1 


I OO 1 1 1 










1 1 O-H 1 


1 1 1 




1 -.CM (M II 




CO 


11 


Eel 


1 1 «a.-H 1 




00^ 1 1 


1 (M 1 1 










1 1 ISO 1 


1 ! 1 


ICO 1 1 


! C^O O 1 1 




o 



1 = 

is 



u a; 3 * "^r 



o s 



o -3 a 
u 

c o 



2'S 

= 3 











• » 
■ a» 








;V3 








• 








. V. 

• 2 
■ 






Viu 

mtal 






1 


'3 


; _i 




1 


S 


1^ 






IS 

o 



-=3 



c = a 
o 0-2 



eg.-: 



5 g 



aj - a « 

a a 



■4S 



P.D. 48 



<M 

rf2 i-i 



O 
CO 



Si 

00 



Ti 







^1 1 1 1 IIOI I 1 lOl 1 


OQ 


— — 1 i ! 1 1 i 1 1 1 1 rH 1 i 


<D 




:iic5iioioiiii:r: : — 


t- 


Ti 




- — , : — ; 1 ->? 1 ! 1 ! 1 1 ! 


t- 


1 1 1 1 o 1 1 1 o o 1 1 [ [ 1 1 1 


00 




- !l^lllr-t||,-l||lllll 




fi 




1 1 1 i-i t 1 1 1 1 1 1 1 I 1 CO 1 1 1 1 1 1 1 


■<# 




S i I 1 1 1 1 1 1 1 1 Ci 1 1 1 1 I i 1 


<M 




— • ; : ' ! ! i 1 ! I ^ ! ( ! ! 1 f ! 


c 


fi 




i 1 i [ i i [ [ ! E 1 I i 1 C3 1 I 1 t f-< 1 1 






1 1 1 1 1 1 1 1 1 1 1 1 1 1 00 1 1 1 1 f-4 1 1 






1 1 1 1 ! 1 1 I I t 1 1 1 ! O ! [ f ! O ! ! 


= 


Ti 






O 




1 t I I i 1 1 1 1 I r 1 1 1 1 1 1 1 1 1 1 t 


o 






1 1 1 1 1 r 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 


o 








o 




I! 1 1 1 1 1 1 1 1 1 1 1 1 r 


o 




1 1 1 1 1 1 1 1 1 1 t 1 i : 111 


o 




_ C- X O M — ;S O O S -<05 W -«? Xr-i^ O-^i-IO 


09 
00 




ea 


■ - r: - -X C!00>ooooo»o-*e30t-ioooe«i-'0 





eao9 I C4i-i I 



MifH I t-lf-l I 



oca I T-io I 



i-J ci « >s -c* t- do i 



•is Q) 



o 

-si ?D 
•"S (M 



Q CO 









1 


Jnasc 
taine 




1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


o 






1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 


o 


2 is 




1 OOOi-Hi-l 1 


1 1 1 1 


1 1 TfeO 1 1 1 rH 1 1 


o 


Oyea 
id ov 






1 1 1 1 


1 OO 1 (Neo 1 1 1 o 1 1 


s 






1 OOt-rHO 1 


1 1 1 1 


1 1 NO 1 1 1 1-t 1 1 








1 ■»*OkO 1 1 


1 1 1 


1 «-t 1 eoeOfH 1 1 1 1 1 1 


'I' 


)5— 61 
years 


fa 


1 ect-iH 1 1 


I 1 1 


1 1-t 1 moir-i 1 1 1 1 1 1 


OS 






1 i-ieci" 1 1 


1 1 « 1 


1 O 1 Oi-iO 1 1 1 1 1 1 


CM 






1 oot-»i5eo»H 


1 MM 1 


1 eOeCNrJ'INI 1 1 1 1 1 1 


N 
iO 


)0 — 6 
years 


fa 


1 soeci-ieotH 


1 T-tO 1 


1 i-IWr^eOrH 1 1 1 1 1 1 


w 








1 1 


1 NOl-HrH,-! 1 1 1 1 1 1 


00 






1 eo««i-i 1 




1 l-lrHCO 1 1 lH 1 1 1 1 1 


CO 


15 — 5! 
years 


fa' 


1 1 


1 OO 1 


1 OOr-l 1 1 tH 1 1 1 1 1 








1 N-^OO 1 


1 1 


1 r-ll-HN 1 1 O 1 1 1 1 1 








t-tiHxtt- 1 1 


1 04 1 


1 1 1-1 1 eo 1 1 1 1 1 


o 

N 


50—5. 
years 


fa 


O CO C4 1 1 


1 O 1 








1-lOiHkO 1 1 


1 M 1 


1 1 O 1 O 1 OO 1 1 1 1 


Oi 




Eh 


1 1 1-IO) 1 1 


M 1 1 


1 M 1 1 eoi-H 1 1 1 1 1 1 


00 


[5 — 41 
years 


fa' 


1 1 OrH 1 1 


O 1 1 


1 N 1 1 eOrH 1 1 1 1 1 1 1 








1 1 1-100 1 1 


M 1 1 


toil OO 1 1 1 1 1 1 





• o 



o 

S 5 a 



c9 04 s« _C +3 ^ 
'■2 C! h 



3 rt-Q 

0) Q, (D 



o ..2 
o . O 

* M Q 



o rt o '':S«3 >> w 
•2 rt « g 2^^ 



rHMCO'<^*U5<Ot-OOCJOrHNffOr(<in>«Dt-OOO^Oi-iN 
rHi-lrHTHi-liHi-l,-li-ii-IMe<IN 



50 



P.D. 84 



•s 

o 

i 

1 

O CO 

S CO 
^ Cs> 

-tes 2? 









1 1 1 1 1 


1 I T-i 1 iai-i 




[2 


II 




o N : 


, , , , 


1 1 — 1 TTi-l 


rH 1 O 1 1 


(N 






I 


1 1 1 1 1 


1 1 O 1 — o 


O 1 r-l 1 1 


«D 






1 c; o 1 




1 1 — MCCN 


11—11 


OJ 

05 


:i 1 




1 TrL= o 1 


11-11 


1 1 ONroiN 


11-11 








1 OiC CO 1 


1 O 1 1 


1 1 — — OO 


1 I O I 1 




1—2 
years 




1 .-icqia 1 


1 1 N— 1 


1 — r-l n — 


1 1 1 - 1 


CO 

c- 




1 C-N'<1' I 


1 OO 1 


I t-lrl — Tj<0 


1 1 1 O 1 


o 






1 ■^O'^ 1 


1 M-H 1 


1 oocoo — 


, 1 .- . 


CO 

CO 




Eh" 


1 TTSlNi-l 


1 1 1 1 


1 1 - 1 - 1 


11-11 


CT> 


2 J 
1 c 




1 coroo-i 


. . , , 


I 1 — 1 O 1 


11—11 


00 






, , , , 


1 1 O 1 — 1 


1 1 O 1 1 






Eh" 


: c-.-^^ : 


: ; 1 i 


; - 1 ; i : 


: : , I 1 








1 ^^.^ 1 


, ■ , . 


1 O 1 1 1 1 


1 1 1 1 1 






1 -^MN 1 


1 1 1 1 


1^. > . , 





o 




h" 


I 5or:o.-i 

CN'-i 


— 1 CD 1 


1 lOi-lt-l 1 1 


1 < , , , 


lO 


II 






i-< 1 O 1 


1 1 1 





CO 


E 




1 ««C50 


o 1 eo 1 


1 NOO 1 1 


, , , , , 


o 

« 


§5 


E^ 


1 OSiCO 1 


1 «S3 1 




II.,. 


o 
to 






1 eco^ 1 


1 Oi-l 1 


1 NO 1 r-l — 





cs 

CO 






1 nOir-t 1 


1 moi 1 


1 CJi-l 1 OO 


1 1 1 1 1 


N 



ti.2 c c 
« ^^S £-5 
g cs a c^XJ 

llllll^ 



sc.. 



C3 O 



1-i CO ec ■>? 1^' w' t> X c> o" — CO 50 u2 o t> (»■ ci o — ©i 
— — — — — — — — — — cococo 



P.D. 84 



61 




62 



P.D. 84 



Table 19. Family Care Department, Year Ending September 30, 1926. 



Males 


Females 





10 





2 





3 





1 











14 





7 





7 

















1 





7 





6 





1 

















14 





4 





7 





8.26 





6.87 





1.30 





.09 





.72 





.07 





.65 



Total 



Remaining in Family Care Sept. 30, 1925 

On visit from Family Care Sept. 30, 1925 

Admitted during the year 

Admitted from visit from Family Care 

Nominally admitted from visit 

Whole number of cases within the year 

Dismissed within the year 

Returned to institution 

Discharged 

On visit 

Discharged from visit from Family Care 

Remaining in Family Care Sept. 30, 1926 

Supported by State 

Private 

Self-supporting 

On visit from Family Care Sept. 30, 1926 

Number of different persons within the year. . . . 

Number of different persons admitted 

Number of different persons dismissed 

Average daily number in Family Care 

Supported by State 

Private 

Self-supporting 

Average daily number on visit from Family Care 

Supported by State 

Self-sunDortine 



10 

2 

3 

1 


14 

7 

7 





1 

7 

6 

1 




14 

4 

7 

8.26 
6.87 
1.30 
.09 
.72 
.07 
.65 



18*39 W.P.A.